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Saturday, May 31, 2003 -- Kanawha City, WV
Run with a Cop 5K for Special Olympics (iPO Event Id#: 5283)

Return to the Details Page

Applications should be mailed by May 23rd, 2003!

Please mail (and make checks payable) to:
Run with a Cop
114 Town Court
Charleston, WV 25312


NAME:_________________________________________________________

ADDRESS:______________________________________________________

CITY:__________________________________STATE:_____ZIP:________

PHONE#:________________________________SEX:______AGE:_________

T-SHIRT SIZE:  S_____  M_____  L_____  XL_____

LAW ENFORCEMENT ___ yes  ___ no

PLEASE CHECK WHICH EVENT YOU ARE ENTERING:

5K RUN___($12)  5K WALK___($10)  FAMILY___($25 - see details)

DAY OF RACE ADD $3
WAIVER: In consideration of the acceptance of this entry, I waive all rights and claims for damage that I may have against the City of Charleston, Special Olympics and all sponsors. I attest that I am physically fit and have trained for this event.
______________________________________________________________
Signature of Participant

______________________________________________________________
Signature of Parent or Legal Guardian (IF UNDER 18 YRS OF AGE)

SPONSOR SHEET Run With A Cop for Special Olympics
Name of Sponsor      Address        Donation      Paid