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Sunday, August 8, 2010 -- Morgantown, WV / Gene's Place, South Park
Gene's Run For Special Olympics WV - MAGP #7
ENTRY FORM
(iPO Event Id#: 12703)

Return to the Details Page

CONTACT: Debbie McCord (phone) 304-292-4126

Pre-registration is $17.00 if paid by July 31, 2010. Thereafter, late fee is $20.00.

Make checks payable to: Monongalia County Special Olympics

Mail entry form and fee to:

Gene's Run for Special Olympics
P.O. Box 41
Morgantown, WV 26505

Run ___ . . . Grand Prix Entrant ___ . . . Walk ___

Name: ___________________________________________________________________________

Female ___ Male ___ // Age on 8/8/10: _______ Birth Date: ____ /____ /____

T-Shirt Size: L ___ XL ___ XXL ___

Address: ________________________________________________________________________

Street: _________________________________________________________________________

City/State/Zip: _________________________________________________________________

Phone (______________) _____________________________________

In return for permission by the Monongalia County Special Olympics to participate in Gene's 4 mile run or walk, I release the program, its members, volunteers, co-sponsors, and other participants from any claim for injury or loss that occurs to me or my child/ward or anyone on his or her behalf. I therefore attest and verify that I am physically fit and have sufficiently trained for this event.

______________________________________________________________________
Signature *

* Parents signature required if contestant is under 18 years of age).