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Saturday, September 15, 2007 -- Morgantown, WV
2007 September Stride 5K ENTRY FORM (iPO Event Id#: 10013)
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Send this form and payment to:
September Stride - West Virginia University Hospitals, Rehabilitation Services
PO Box 8060, Morgantown, WV 26506-8060

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.
I hereby -- for myself, my executors, and my administrators -- waive any and all rights and claims I may have against West Virginia University Hospitals, individuals associated with this event, sponsors of this event, or suppliers for injury or damages suffered by me and which may arise out of or in any way be connected with this event. I knowingly assume all risks involved in this event.

Signature of participant

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