Lion’s Club – River Shiver



Polar Bear 5K Run – Walk

Registration Form




February 18, 2012


Ogdensburg Community Center


Race starts at 10:00 AM




Pre-register by 2/11/12 to guarantee your long-sleeve Tee




Name ________________________________  Date of Birth________________



Address ______________________________  Age_______ M or F__________



              ______________________________   Runner______Walker_______



Phone ___________________ E-mail:__________________________________



T-Shirt Size    S ______ M_______L_______ XL_______1X_______2X_______

(unisex size)



Pre-registration is $15.00 and must be received no later than 2/11/12. Late entries received after 2/11/12 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 rroethel@twcny.rr.com .



Race day registration begins at 9:00AM at the Ogdensburg Community Center on Riverside Avenue.  Long-sleeve tees will be given to late and race day entrants as available.   All participants under 18 years of age must have the consent of a parent or guardian by signing this form below.



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