Saturday, October 20, 2007 -- Wheeling, WV / Warwood Middle School-Heritage Trail
Auggie's 5K
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Please make checks payable to: Ohio County SPCA
Mail entry forms to:Tom Rownd, 609 Chuckie Lane, Wheeling, WV 26003
Name_________________________________________________________ Address______________________________________________________ City, State, Zip_____________________________________________ Phone_________________________ Email:________________________ Age on race date (10/14/07)_______________ ____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) Male _____ Female _____ Runner _____ Walker _____ Shirt Size:(circle one) XXL, XL, L, M, or SWaiver: 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)