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The Oakville Beaver Weekend, Saturday May 27, 2006 - 33 Presented by 2006 Sunday, June 18th, 2006 Father's Day Rain or Shine 8:45 a.m. - Warm Up for 200 9:00 a.m. - Fun Run, ew N Run & Powerwalk 9:15 a.m. Walk All proceeds go to the Oakville-Trafalgar Memorial Hospital Intensive Care Unit (ICU) Location: Wallace Park, between Reynolds and Allan, just south of the Hospital. Fun Run 1 km 6 Registration & Pledge Forms available at: · OTMH Main Lobby - 327 Reynolds Street, Oakville · Oak-land Ford Lincoln - 570 Trafalgar Road, Oakville · The Running Room - 156 Lakeshore Rd. East, Oakville On-line at: www.otmhclassic.com OR www.events.runningroom.com Or call: Aleta Mayer at (905) 845-2571 ext.4351 E-mail: amayer@haltonhealthcare.on.ca OTMH Classic Official Pledge Form Sunday, June 18th, 2006 All proceeds to the Intensive Care Unit (ICU) of the Oakville-Trafalgar Memorial Hospital Note: Please print your name and address clearly on both the Entry and Pledge Forms and check the appropriate boxes. First Name: Address: Telephone: Adult Runner Individual Par ticipation Last Name: City: Postal Code: E-mail: Have you par ticipated before? Youth (18 years and under) Power Walker Team Par ticipation Family Runner Name of Team: Yes No Entry Form One entry form should be completed for each participant or per family entrant. (Receipts will be provided for contributions of $20 or more, if requested.) Name Address Street/ City Postal Code Phone# Collected $ Cash Cheque Receipt Req'd($20+) First Name:* Address:* City:* Postal Code:* Male Last Name:* Prov.:* Phone #:* Age:* Female (Age required to be eligible for race prizes) (*) indicates required field R. K. Kelly (sample) 35 Grandview Street, Oakville L6J 4P9 905 555 555 300 Registration Fees For Run & Walk (no refunds) Note: All 5km and 3km participants receive an event T-shirt. Please check: 5km Run 5km Power Walk 3km Walk 1km Fun Run, children 10 & under $5 (t-shirt not inclu.) Adults and children age 15 and over: $25 $10 $50 After June 5th After June 5th After June 5th $35 $15 $80 if 18 yrs or older Children age 14 and under: Family of 4: (maximum 2 aged 15 & over) NAME 1 2 3 4 SEX AGE EVENT BIB # SIGNATURE Payment Options VISA MC CASH CHEQUE AMEX (Cheques payable to Oakville Hospital Foundation) Card#: Name on Card: Expiry Date: Signature: Total pledges collected: $ Pledge Forms and all funds received must be handed in at the Pledge Desk on Sunday, June 18th, 2006. Amount: Month Year 2006 CLASSIC WALK/RUN RELEASE & INDEMNITY In consideration of the acceptance and the permission to participate as an entrant or competitor in the 2006 Classic Walk/Run I, for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE Oakville Hospital Foundation, Oakville-Trafalgar Memorial Hospital, the organizers and sponsoring companies from any and all claims, demands, injury, loss or damages, costs, expenses, action, and causes of action whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in the said event, whether as a spectator, participant, competitor; whether prior to, during, or subsequent to the event AND NOTWITHSTANDING that the same may have been contributed to or occasioned by the negligence of any of the aforesaid. I HEREBY UNDERTAKE TO HOLD AND SAVE HARMLESS AND AGREE TO INDEMNIFY all of the aforesaid from and against any or all liability incurred by any or all of them arising as a result of or in any way connected with my participation in this event. BY SUBMITTING THIS ENTRY, I ACKNOWLEDGE HAVING READ, UNDERSTOOD, AND AGREED to the above WAIVER, RELEASE, and INDEMNITY, I WARRANT that I am physically fit to participate in this event. If this registration is a family registration and one or some of the participants is/are under the age of 18 years, I, being the responsible parent/guardian for such participant(s) under the age of 18 years, agree that the foregoing consent and release will apply on behalf of such participant(s) under the age of 18 years. I give full permission for the use of my name, photograph, electronic and video image by any of the parties (as defined above). Oakville Hospital Foundation respects your privacy and we protect your personal information. We do not rent, sell or trade our mailing lists. The information you provide will be used to keep you informed of the Foundation's fundraising opportunities. If you would like to be removed from our contact list, please call us at 905-338-4642. Sponsors and Supporters The Oakville Hospital Foundation invites you to join Oak-land Ford Lincoln and Ford Motor Company in supporting this worthy cause by sponsoring or by participating in the run or walk and by pledging donations through your colleagues and friends. Presenting Sponsors Silver Sponsors Bronze Sponsors Gold Sponsors Oakville Curling Club IMAGE & MORE Community Sponsors · Blue Line Distribution Ltd. · Cogeco Cable · D'Orazio Infrastructure Group · Franklin Templeton · Genex General Exhibition Corporation · Home Depot · Lulu Lemon · Mattamy Homes · Naylor Group · Oakville Blueprinting & Copy Centre · Oakville Hydro · Oakville Italian Club · Price WaterhouseCoopers · Prudential Realty · Royal LePage · Scotiabank · Whole Foods Market · Wow Power Walking Single Entrant Signature: Family Entrant Signature: Parent/Guardian: (if under 18 yrs.)