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Saturday, October 15, 2005 -- Wheeling, WV
Auggie's 5K Run & Walk (iPO Event Id#: 6852)

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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 (10/15/05)_______________

____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)