Reuel Little Classic P.O. Box 692 Madill, Oklahoma 73446 coralann_g@sbcglobal.net

Last Name ____________________________ First Name ________________________

Address ______________________________ Phone (_____)______________________

City ___________________ State _______________ Zip Code ____________________

Age on 10-08-11 ______________ USAT&F _________________ Sex _____________

5k __10K __½ M __ Fun run/walk __ Email address ___________________________

T-Shirt Size S___M_____ L ______ X-L _____ XXL _______ (add $2.00 for XXL)

Signature Date Parent signature if under 18 years old