REGISTRATION FORM

Printed Name: ________________________________________________

Address: _____________________________________________________

City: _______________________ State: _______ Zip: ____________

Phone: (H) ______________________ (W) ________________________

Payment Type: (_____ Check), (_____ MasterCard), (_____ Visa).

MC ___ or Visa ___ Expiration Date ___________________________

Credit Card Number __________ __________ __________ __________

Total amount enclosed: $______________________________________

Pet(s) Name(s): ______________________________________________

Type of Pet(s) & Breed(s): ___________________________________

SPCA Alum? _______ Rabies Vaccination Number(s): _____________

______________________________________________________________

___ Enclosed is my registration fee (or) ___ Attached is my sponsership pledge form

___ I am interested in adopting

___ I would like to foster-walk a dog from the SPCA shelter

___ I cannot participate in the walk but here is a donation to sponser Roxy in Pet Trek '99

___ I am interested in forming a team of walkers--please send me team info.

Waiver Statement
In consideration of this entry, I, the undersigned, do waive any and all claims for myself and my heirs against the Raleigh Jaycees, the Garner Jaycees, or the SPCA of Wake Country, and Sponsors, and all officials of this walk for any injury or illness which may directly or indirectly result from my participation in Pet Trek. I state that my pet(s) and I are in proper physical condition to participate in this event. Warning: I understand that high heat and humidity can be extremely dangerous and that I will not overexert myself or any animal(s) under my control under these conditions.

Signature ____________________________________________________

Parent or guardian must sign below if registrant is younger than 18 yrs. old:

Parent or guardian ___________________________________________

REGISTRATION/DONATION FEES
You can either register for a $20.00 fee (per "family") or you can solicit sponsors for a $20.00 minimum donation. If you wish to pre-register, please fill out the form above and send to: Attn: Pet Trek '99 c/o Raleigh Jaycees, P.O. Box 20244, Raleigh, NC 27619, by Friday, September 3rd. You may also register the morning of the event. Please have all donations turned in on or before the day of the walk. If you wish to participate with a team, please check the appropriate line above and information will be sent.