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Saturday, August 25, 2001 -- Elkins, WV
Kenneth Cunningham 5K Memorial Cross-Country Run (iPO Event Id#: 3776)

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METHOD OF PAYMENT: Make all checks payable to:
    "Elkins Middle School Cross-Country" or ( E.M.S. Cross-Country )
Send entries to:
    Ken's 5K x-c Run
    c/o Todd Price
    Rt.3, 213 Hickory Drive
    Elkins, WV 26241

ENTRY FEE: For 5K run - $10.00 before August 22nd 2001. $12.00 after August 22nd & on race day. Pre-registration is encouraged.

ENTRY FEE FOR KIDS EVENTS: $5.00 for Fun Run - $8.00 for 1/2 mile run.

*** All proceeds will benefit both Elkins Middle and Elkins High School Cross-Country teams ***


NAME:_____________________________________  SEX M___F___

Age as of 08/25/01________

Address_________________________________________________

City________________________ State_____ Zip_____________

Phone_____________________ Shirt Size: S____ M____ L____

Check all that apply: 

     Kids Fun Run___   1/2 mile Kids CC run____  

     5K CC run____  Participating in team event___
I, the undersigned, in consideration of my entry in the Kenneth Cunningham 5K cross-country run, do certify that I am physically fit and suitably trained to participate in said event. I agree to be bound by all rules of the race and decisions of the officials. I hereby forever release and discharge the organization and sponsors holding this event, its agents, representatives, successors, and assigns from any and all claims, courses of action, and suits which shall or may have arisen as a result of my participation in said event.
_________________________________________  _____________
SIGNATURE OF APPLICANT                         DATE

_________________________________________  _____________
SIGNATURE OF PARENT/GUARDIAN (IF UNDER 18)     DATE