Saturday, October 18, 2008 -- Wheeling, WV
Auggie's 5K Run & Walk Entry Form
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Please make checks payable to: OVRWC // Mail to: Tom Rownd, 609 Chuckie Lane, Wheeling, WV 26003
Name_________________________________________________________
Address______________________________________________________
City, State, Zip_____________________________________________
Phone_________________________ Email:________________________
Age on race date (10/18/08)_______________
____I would like to volunteer to help before, during,
or after the race.(Circle one or more.) Please contact me.
____I would like to donate $______ in memory of - or - in honor
of _______________ (pet's name)
____I would like to buy ______ # of Auggie Race Hats at $10 per hat.
Male _____ Female _____ Runner _____ Walker _____
Shirt Size:(circle one) XXL, XL, L, M, or S
Waiver:
In submitting this entry, I, intending to be legally bound for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims which I may hereafter accrue against the Ohio Valley Runners & Walkers Club, Inc., OCSPCA, any event sponsors, event volunteers, event staff, and their officers, directors, agents, successors and/or assigns for any injuries suffered by me at this event while traveling to and from the event or while participating in it. I attest and verify that I am physically fit and sufficiently trained for the competition of this event. I understand that I may be photographed and agree to allowing my photo, video, or film likeness to be used for any legitimate purpose by the aforementioned parties.
Signature___________________________________ Date____________
Signature___________________________________ Date____________
(Parents Signature if under 18)