***DO NOT SEND ENTRY FEE WITH APPLICATION; YOU MUST BE CONFIRMED***

MOST SPECIAL NOTE: While there are no specific Rules; they are ,of course, subject to change.

Slug Mail to: John Harper, 240 Beechwood Avenue , Dover , DE 19901
E-mail, Website: teamslug1@comcast.net , Team Slug Webpage
Name_______ Charles Sayles ___________________

Address_____222 Monterey Road #1402__________

 ___________Glendale, CA 91206_______________

Phone_(818) 679-6372________________________
Slug / (Non-Slug(; T-Shirt size: (small) L /XL
E-mail:___charles.ts@csayles.com________________ -----------------------------------------------------------------------------------------------------------
*I understand to run this distance is dangerous and ridiculous. The RD has advised me not to do it. I choose to do it of my own free will, and hold no other person or party responsible/liable for injury except for myself:

________Charles W. Sayles____Charles W. Sayles_____2 /28/2006_____________
Printed Name/ Signature/Date