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Sunday, May 26, 2002 -- Point Marion, PA
Albert Gallatin Regatta 5K (MAGP #3) (iPO Event Id#: 4906)

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Mail To:
Albert Gallatia 5K
P.O. Box 1496
Morgantown, WV 26507


NAME:____________________________________________________________________

ADDRESS:_________________________________________________________________

CITY:________________________________________ STATE:_____ ZIP:____________

CHECK ONLY ONE:    5K RUN______     5K WALK______

T-Shirt Size - M____L____XL____     Male_____ Female_____

Age on 5/26/02 ________

Race Waiver - Must be signed!
In consideration of your acceptance of my application for the entrance in the Albert Gallatin Regatta 5K Run and 5K Walk, I , for myself and anyone entitled to act on my behalf, waive and release the Albert Gallatin Regatta, the Race Director, The Mental Health Association of Monongalia County, and all sponsors, volunteers, officials, and their representtatives and successors from all claims or liabilities of any kind arising out of my participation in this event.
______________________________________________________
Signature (required)

______________________________________________________
Parent or Guardian MUST SIGN if under 18

______________________________________________________
Date