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Saturday, October 17, 2009 -- Wheeling, WV / Warwood Middle School, 150 Viking Drive, Wheeling, WV 26003
11th Annual Auggie's 5K Run & Walk ENTRY FORM (iPO Event Id#: 12017)

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Fee: $15 - Adults (plus kids 16 and older), $10 - Kids (15 & Younger) // Can't participate? Donations are Welcome!

Please make checks payable to: OVRWC

Mail to: Tom Rownd - AUGGIE'S 5K, 609 Chuckie Lane, Wheeling, WV 26003



City, State, Zip_____________________________________________
Phone_________________________ Email:________________________

Date of Birth (month, day, year) _____/_____/__________

Age on race date (10/17/09)_______________

____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  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)