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Saturday, March 29, 2008 -- Charleston, WV / Behind CAMC Memorial, WVU Medical Building
Joker 4-Mile Run and 2-Mile Walk

(iPO Event Id#: 10890) -- Return to the Details Page

Make Checks Payable / Mail Registration To:
Charleston Parks & Recreation, 200 Baker Lane, Charleston, WV 25302

Name: _____________________________________________________________

Address: __________________________________________________________

City/State/Zip: ___________________________________________________

Phone: (_________)______________ Cell:(_________)______________

E-mail: ___________________________________________________________

Please Check All That Apply:

Male ______ // Female ______ ... 4 Mile Run ______ // 2 Mile Walk ______

Circle Age Division: 19 & Under, 20 + 29, 30 + 39, 40 + 49, 50 + 59, 60 & over

Youth Shirt Size: Med OR Adult Shirt Size: Small / Med / LG / XLG / 2XLG

Waiver: I, the undersigned, waive and release myself, my heirs, executors, and administrators, any and all rights and claims for damages, demands, and any other actions whatsoever, which I may have against all participating sponsors and supporters and The City of Charleston, arising out of my participation in this event, including and all injuries, including death suffered me as a result of my participation in this event. I consider myself adequately trained for the completion of this event. Should I suffer an injury or illness, I authorize officials of this event to use their discretion to have me medically treated and transported to a medical facility. I also authorize the sponsors to use any photographs or video taken of me to be used in any promotional materials.

Signature: ________________________________________________________

( Parent/ Guardian Signature Required Under 18 years of Age )

Date: ___________________________________