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