Saturday, June 3, 2000 -- Kanawha City
Run with a Cop 5K Run/Walk
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Applications should be mailed by May 27th, 2000!
Please make checks payable to: Law Enforcement for Special Olympics
NAME:_________________________________________________________ ADDRESS:______________________________________________________ CITY:__________________________________STATE:_____ZIP:________ PHONE#:________________________________SEX:______AGE:_________ T-SHIRT SIZE: M____ L_____ XL_____ PLEASE CHECK WHICH EVENT YOU ARE ENTERING: 5K RUN_____($12.00) 5K WALK_____($10.00) DAY OF RACE ADD $3WAIVER: In consideration of the acceptance of this entry, I waive all rights and claims for damage that I may have against the City of Charleston, Special Olympics and all sponsors. I attest that I am physically fit and have trained for this event.
______________________________________________________________ SIGNATURE OF PARTICIPANT ______________________________________________________________ SIGNATURE OF PARENT OR LEGAL GUARDIAN (IF UNDER 18 YRS OF AGE)
SPONSOR SHEET Run With A Cop for Special Olympics
Name of Sponsor Address Donation Paid