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NAME ADDRESS CITY STATE, ZIP PHONE AGE (on 6/12/10) BIRTHDATE MALE FEMALE EMAIL (OPTIONAL) SHIRT SIZE: Youth M Adult S M L XL Tank top (Adult sizes only) or Tee shirt WAIVER: I waive for myself, my
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15K Marion BIRTHDATE WV Fairmont XL 5K yrs assigns pre Literacy payable heirs Locust WAIVER OPTIONAL Ave waive sponsors

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