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8thANNUAL WESTERN NEW YORK CHARITY FUN RUN
EAST PIER MARINA
512 River Road, North Tonawanda, New York 14120
PLEASE CALL US at (716) 693‐6604 for any questions regarding the event!
Owners Name: ___________________________________ Date ____/____/____
Address: ___________________________________________________________
City: __________________________________State: _______ Zip Code: ________
PHONE; Day: (___) _________ Evening: (___) ___________Cell: (___)__________
Email Address: _________________________________
Make of Boat:________________ Model: _________ Length:_______ Year: _____
Name on Boat: ________________________ Registration # _________________
Total Number Registering: _________ OSO MEMBER Name: _________________
| Captain: ___________________________ | Shirt Size: ___________ | PDF's |
| Crew: ____________________________ | Shirt Size: ___________ | |
| Crew: ____________________________ | Shirt Size: ___________ | |
| Crew: ____________________________ | Shirt Size: ___________ | |
| Crew: ____________________________ | Shirt Size: ___________ | |
| Crew: ____________________________ | Shirt Size: ___________ | |
FEES FOR BOAT AND DRIVER $100.00 (Cost includes One Shirt)
EACH ADDITIONAL PERSON: $25.00 (Includes Additional Shirt)
All drivers and crew must sign a waiver prior to the event!
Signature of Captain: ________________________ (TOTAL $________)
Make Checks Payable to: Western New York Fun Run, LLC
Proof of Insurance Required! This is a Coast Guard Approved Event!