Online Registration Gender Female Male Runner/Walker Runner Walker Title Mrs. Mr. Miss Ms. Dr. (required) First Name (required) Last Name (required) Date of Birth Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 Address 1 Address 2 (required) City/Town Prov/State Country Postal/Zip Code Phone (required) Email Address T-Shirt Size small medium large X-large XX-large ORA/OTFA(AO) # Do you want the race results emailed to you? No Yes Method of Payment? Online (PayPal or Credit Card) Cheque or cash on race day Name of Parent/Guardian if you are under 18 years of age ***Release Form*** The Shore to Shore Road Race is open to any runner or walker. It is sponsored by Wiarton District Family Literacy, and the Ontario Road Runners Association, which reserve the right to refuse entry to any applicant not of legal age, unless authorized by a parent or guardian. The sponsoring clubs will not be held responsible for any injury or illness which may result from participation in this race. Competitors participate at their own risk. By submitting this entry, I acknowledge having read and agree to the above terms of this release (required) I have read and understood the conditions