w4w Brochure e
w4w Brochure e
w4w Brochure e
Registration Information
Walker _____________________________________________________________________
Address ____________________________________________________________________
City, State, Zip ______________________________________________________________
Phone _____________________________________________________________________
Email ______________________________________________________________________
T-shirt size (comes with minimum pledge level of $35) ___________________________
Waiver: In consideration of my signing this agreement, I hereby for myself, my pet, my heirs and
administrators assume any and all risks associated with the Walk for Wags.I waive and release any and all
rights and claims for damages which I may have against the organizers, The Humane Society of Portage
County, Inc. and any others connected with this event, their representatives, successors and assigns for any
and all injuries or damages of any kind whatsoever suffered by me or my pet as a result of taking part in the
Walk for Wags and any related activities.
Signature___________________________________________________________________
Date_______________________________________________________________________
Parent or Guardians Signature (if under 18)_____________________________________
Age (if under 18)____________________________________________________________
$500
$100
Pledges
Name
Phone
$ Pledged
$ Received
___________________________________________________________________________
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TOTAL _____________________________________________________________________
You may register and make credit card payments at www.hspcwi.org
My donation:
Mail to:
Humane Society of Portage County
3200 Iber Lane, Plover, WI 54467
Fax to: 715-344-5954
You may register, donate and make
credit card payments at www.hspcwi.org
For more information, call 715-344-6012
Printing donated by Spectra Print, Inc./Design donated by Hoot Communications