Name: _________________________________________________________________

Address: _______________________________________________________________

Phone: ________________________ E-mail: __________________________________

Age on 9/15/07: ________________  DOB: _____/_____/____   Male   Female

Event:   5K Run    5K Run/Heavyweight    5K Walk

T-shirt size:   M    L    XL    XXL

If you're an employee of the WVU Health Sciences Center Campus, 
please check the correct entity:

 WVUH    UHA    WVU Health Sciences

Will you be attending the pasta dinner?   Yes    No

How many guests are you planning to bring to the pasta dinner?
_____ (Please note: If your guest/s is/are not participating in the event, 
the cost is $5 per person.)

Race fee is $15 for the general public and $13 for employees 
(WVUH, UHA and WVU Health Sciences) if postmarked by Friday, Sept. 7. 
The discount does not apply to employees' family members. 
After this date and on race day, the cost is $18 
for the general public and employees.

                Registration fee: $_________
                Pasta dinner: $_________
                Donation to Rosenbaum Memorial Fund: $_________
                Total enclosed: $_________         
                
                Make checks payable to WVUH. No refunds will be given.

________________________________________________________________
Signature of participant

________________________________________________________________
Parent's or guardian's signature (if under 18)

___________________________________________
Date