Pike County Outreach Council of Churches

107 West Second Street
Waverly, Ohio 45690
Phone: 740-941-4348
E-mail: pikeoutreach@gmail.com

Pike County Outreach - Annual 5K Run & Walk Registration Form

Register Here!

Please enter your first name:

Please enter your last name:

Please enter your street address:

Please enter your City:

Please enter your State:

Please enter your Zip Code:

Please enter your email address:

Please enter your phone number:

When is your birthday? (We need this
to determine your race category)
Format birthday as MM/DD/YYYY:

Are you...

Male or Female

What is your shirt size?

Small Medium
Large X Large
XX Large NONE (No Shirt)

Are you signing up to...

Walk or Run

You can submit your $15.00 payment on the next screen.
( $20.00 after November 5th )

Click this button to donate with a credit card...

Please make your tax-deductible donation check payable to:

Pike County Outreach Council,
or Bridgehaven

Mail it to: Pike County Outreach Council
107 West Second Street
Waverly, Ohio 45690

Copyright © 2013 Pike County Outreach Council of Churches, Inc.
overlib code copyright © Eric Bosrup