Name:________________________________________________________
	(First)		(Middle)	(Last)

Address:_____________________________________________________
	(Street)	(City, State)	(Zip)

Home Phone Number:___________________________________________

Parents Names:_______________________________________________

Name of High School:_________________________________________

High School Address:_________________________________________
			(Street)	(City,State)	(Zip)

Local Newspaper's Name:______________________________________

E-Mail Address:____________________	Phone:_______________

Local TV Station's Name"_____________________________________

E-Mail Address:____________________	Phone:_______________

Number of Years Running Cross Country?_______________________

List Honors or Awards Received During Your Cross Country Running Career.

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Have you enclosed your check for $75 to pay for your room and uniform? This is to be sent with this application.

Return to:
David Evans
15 Pleasant Drive
Cameron, WV 26033
Phone: 686-3740 after 6:00 PM

Must be received before November 5, 2001.

I will be at the A-AA awards ceremony and Chris Parsons/Sallie Hunter will be at the AAA awards ceremony. We will take your forms if you are ready to return them to us.