Ogdensburg School

100 Main Street, Ogdensburg, NJ 07439

or fax to (973) 827-0134

or e-mail info to ghediger@obboe.com

Forms due no later than April 16, 2009

Registrations accepted the day of the event.

Print Name ____________________________________________

Address _______________________________________________

Organization or Business _________________________________

Address _______________________________________________

Minimum Donation: $15 individual

$25 per family

$75 group

Make checks payable to: SCEA Philanthropic Fund

I understand and agree that I am voluntarily participating in the Kathy Del Ben Walk and assume all risks and hazards incidental to such participation. I waive and release all rights and claims for damages against the NJEA/SCEA, its employees, officers, volunteers, sponsors, and other participants for any and all injuries that may be suffered while participating in this event. I also give permission for the SCEA to make non-commercial use of any event, photographs of my children or myself.

SIGNATURE _____________________________________________________

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