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Saturday, October 12, 2013 -- Wheeling, WV / Warwood Middle School
Auggie's 5K Run & Walk ENTRY FORM (iPO Event Id#: 14553)

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RACE CONTACT: Tom Rownd (phone) 216-501-2188 (e-mail)

Wind jackets with original artwork will be reserved for the first 200 registrants.

ADULT = $20.00 until 10/09/13, $25.00 thereafter // YOUTH (age 15 and younger = $14.00 until 10/09/13, $16.00 thereafter

Please make checks payable to: OVRWC and 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 (10/12/13)____________________________

_______ 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.



          (Parents/Guardian Signature if under 18)