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Oh-Mich-Iana

Headquarters Hotel

EVENT	Check to sign up	One A Award & Credit (by 8/1/04)	One A Award & Credit (after 8/1/04)	Credit Only	Total Enclosed
Vice President’s Walk		$3.00 Credit Only A Award at Event Only	$3.00 Credit Only A Award at Event Only	$3.00
Auburn Walk		$6.00	$7.00	$3.00
Quincy Walk		$3.00	$3.00	$3.00
Auburn Bike		$3.00	$3.00	$3.00
SIGN UP 3 WALKS & BIKE BY 8/1/04		$15.00	$16.00	$12.00
2 Friday Swims		NA	NA	$6.00
2 Saturday Swims		NA	NA	$6.00
Total Submitted					$

For additional information, contact Becky Adams at

3dognight@cityofbryan.net

Name: ___________________________________________________

Address: _________________________________________________

City: __________________________ State: ________ Zip: __________

Phone: ____________________ E-mail: _________________________

Complete form and mail by August 1, 2004 to:

Oh-Mich-Iana

c/o Randy & Becky Adams

1018 Colonial Lane

Bryan, OH 43506

Pre-registration Form

Please complete one form for each participant