DATE: Saturdayr Oct 4tt' Please cornplete the above TIME: 'IO:OO AM infonnation, attach acheck and send to Porfville Am efican Legion Auxiliary Vwt I 1 4 Registration Time: YO. Box 733, Portville, NY 1477O 8130 am- 913O am Portville Central School BENEFITS: Breast Cancer Awareness Ararglq..dl o.J? lH!qb:@ - Ro,uNlD 6 Hosted by the Portville American Legion Auxiliary Unit 814 5K WALK / RUTTI One form per registranl {Please Print} AGE- NAME PHONE( Mele l-l ru-"t F-MAII- Ufalking [ 4"""*g ADDRESS Survivor T-SHIRT SrZE (CrRCtE The day ofthe race upon completion registration, before (Sept 24 th ), ofyour registrstion there will br a 20.00 registrotion the fee will be 18.00, send your regictration and fee ONE) tf n S M L Xr, zxr fec to be considered for thi$ event and receive your $(L t-shirt. For pre- to address above. In addition to that you can earn another t-shlrt by obtaining eponsors with the arncunt of 5l|.00 or more, turn sponsor sheet with money in the day of the racellake check payahle tn: Psrtville Amcrican legion Auxiliary Unit 814 Intal I WAIVER AI{D RELEASE STATEIIEI{T (All Athletesmnstread and sign) I hrre reed tLe rcomp*yiag event inhrmetion end understmd rhe polkies of lhe evelt. I lnow 6at runaiag haz:rdous actnrity. I should trot enbr oakes I cvent, incluJing but not to, &Ih am contect qrticrlV in a str€€t rirce is a ebh rnd pmpedy treined. I rsflrme.I tisb afsoci.b.l witt uyvolunury poteatielly \ prrttipabn in rfiir wi& otler partkipants, the efiecg of tle weetLer, inchding eatleme bnFr.tu!c*, traffc aad all coaditbns lnown eld epplecLd by ne. Kaowing Scse 6ct* aad in conside'ration ofyour accepting ny entry, I for mTsclf , uy Leirs , erecutors, illminisaetor$, ot ilyorr€ dse wLo niglt cLia 611 my tehrlf ( Portville Amcrken Legi,on ,Portville Schoo[ Villege of Portville rnd any I ell spoasors, of dl t-tted ild wdting gnctr risle being contribubrc, end donors to &e Angel of Hope Eveat), covenrnt aotto sue end waive, RELEASE AND DISCIIARGE all sponsor, nce o$cirlg wor}srs or tlcir tpreenbtives' srcceseolr ot rrsigns 6t ANYAI{D lll! 'lrin* sr lieblity' v&etf,er h1escen or unbrceceq pmpcr$rdrnegs edsing out of, or in &e cour* of uy parttipetion in rlis cvent I hr&er and or rgents eu&orlzed by gmt frll pern!*ion o tlc br rteei6' pcrsonl i$ury or above meationed sponlorr, orgrrrizers then, to ure ery phoogrephs videotepca, motioa picturer; reconliags or o6er recoril of tf,e erent 6r uy rceeoneble pqpose. Participant Signature (or signature of Parent or Guardian if entrant is age 17 os undef) For more information and sponsorsheets please contact: Nette Ratzel (585)307 7563, Jody Lowe (585)933 63fo