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Saturday, May 4, 2013 -- Morgantown, WV / Jack Roberts Park
Parents' Place 5K Run/Walk - MAGP #2 (iPO Event Id#: 14468)

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RACE CONTACT: April Oliverio (phone) 304-216-2119 (email) april_slokan@yahoo.com

Entry Fee: $18 before April 24, 2013, $20 thereafter. Fees are nonrefundable.

Make checks payable to: Parents' Place ... Mail to: April Oliverio, 2019 Ices Ferry Drive, Morgantown, WV 26508

Name:____________________________________________ Phone:_______________________

Address:__________________________________________ Date of Birth:_____________

Age as of 5/4/13:________ / Male:___ or Female:___

Additional Donation for Parents' Place Scholarship Fund: $1.00_____ $5.00______ Other $______

T-shirt size: Small:___ / Medium:___ / Large:___ / X-Large:____

Please check your choice for the event: Running_________ or Walking__________

In consideration of your acceptance of my application for entrance in the Parents' Place 5K, I, for myself and anyone entitled to act on my behalf, waive and release Parents' Place and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I also release any photos that may involve myself::

Signature: ___________________________________________________________________

Date: __________________

Entrant's Signature Parent of Guardian, if under 18:

Signature: ___________________________________________________________________

Date: __________________