Run to Read Races (MAGP #7)

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Saturday, June 25, 2005 -- Fairmont, WV
Run to Read Races (MAGP #7) (iPO Event Id#: 6758)

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NAME ______________________________________________

ADDRESS____________________________________________

CITY_______________________________________________

STATE, ZIP ________________________________________

PHONE _____________________________________________

AGE ____(on 6/25/05)  BIRTHDATE ____________________

MALE_____________FEMALE_________

EMAIL (OPTIONAL)___________________________________

SHIRT SIZE: Youth L__ Adult S___  M___  L___  XL___  

Tank top (Adult sizes only)_____ or Tee shirt______

WAIVER: I waive for myself, my heirs, and assigns, all claims for damages which I might have against the race, its sponsors, or any other organization, business, or individual as a result of any and all injuries which might be received during the contest. I also release any photos that may involve myself.

________________________________________________
SIGNATURE 
(A Parent MUST sign if racer is under 18 yrs old)

Please make all checks payable to: Literacy Volunteers of Marion County

Mail check and pre-registration form to:

LV of Marion County
601 Locust Ave.
Fairmont WV 26554

Entry Fees

5K Run ---- $12 ($15 after 6/20/05)
5K Walk ---- $12 ($15 after 6/20/05)
15K Run ---- $12 ($15 after 6/20/05)
15K + 5K*** ---- $15 ($20 after 6/20/05)
Fun Run ---- $8 ($10 after 6/20/05)

*** Double-entered runners: $15 entry fee ($20 late)
Covers timing in 2 events, up to 3 awards and 1 shirt

Affiliates: WVMBA | MAGP | WVMTR | APRRS | WVCXS