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Friday, June 30, 2006 -- Charleston, WV
Independence Day Celebration Race (iPO Event Id#: 7545)
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Make Checks payable to/ Mail registration to: Charleston Parks & Recreation
200 Baker Lane, Charleston, WV 25302



Name____________________________________________________________

Address:__________________________________________________________

City/State/Zip______________________________________________________

Phone:_________________________ Email:__________________________

Please check all that apply: Male___ Female____ 5-K Run___ 2MileWalk___ 

Age Division(CIRCLE ONE): 
19 and under, 20"29, 30"39, 40"49, 50"59, 60 and over

Shirt Size: Youth:    M        Adult:    Small   Med    Lg    XLg    2XL