107 West Second Street
Waverly, Ohio 45690
Phone: 740-947-7151
E-mail: pikecountyoutreachcouncil_AT_yahoo_DOT_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:

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How old are you...

Are you...

Male or Female

What is your shirt size?

Small Medium Large
X Large XX Large
XXX Large

Are you signing up to...

Walk or Run

Note: You must send your check or money order for $15 to:
Pike County Outreach Council
5K Run/Walk Registration
107 West Second Street
Waverly, Ohio 45690
Your Registration will be processed upon receipt of payment.

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

OR...

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