02/05/2015
Lion’s Club – River Shiver
Polar Bear 5K Run/Walk
(or) 1 Mile Run/Walk
Registration Form
February 14, 2015 - Race starts at 10:00 AM
Ogdensburg Community Center
Pre-register by 2/7/15 to get your long-sleeve Tee.
Name ________________________________ Date of Birth________________
Address __________________________________________________________
Age_________M_______ or F______ Runner _________Walker_________
Phone ___________________ E-mail: (required)_______________________________
I will participate in the (check one) _______5K Run/Walk (or) _______1Mile Run/Walk
T-Shirt Size S ______ M_______L_______ XL_______2X_______(unisex size)
Pre-registration is $15.00 and must be received no later than 2/7/15. Late entries received after 2/7/15 and Race Day entries are $18.00. Please mail completed form along with entry fee to Lion’s Club Polar Bear Run – Walk, PO Box 252, Ogdensburg, NY 13669 or bring to the Medicine Place at 511 State Street, Ogdensburg. Please, make checks payable to Lion’s Club Polar Bear Run/ Walk. Send questions to [email protected] or call 393-1840.
Race day registration begins at 9:00AM at the Dobisky Center on Riverside Avenue. Long-sleeve tees will be given to pre-registered entrants. All participants under 18 years of age must have the consent of a parent or guardian by signing this form below. Registration and entry fee must be received before racer can participate in the event. Once form and fee are received, the participant will receive a confirmation e-mail.
The Lion’s Club and its members, the Ogdensburg Chamber of Commerce and its employees, and the City of Ogdensburg and its employees will not be held responsible for injuries sustained by individuals participating in this event that are caused by the participant’s own actions or negligence or the actions or negligence of a third party other than those named above.
Participants signature Dated Parent/Guardian signature Dated