2011 LIONS - Delta Gamma Walk-a-Thon

For the benefit of "Leader Dogs for the Blind"

and other local Lions Sight Conservation projects

Sponsored by the Blacksburg Host Lions Clubs

Saturday, September 10, 2011

Start at 9-10 AM, finish before noon.

Walker's Name	Dog's Name			Address				Phone Number
Print Sponsor's Full Name and Address			Phone No.			$/Mile	Donations Only		Total Amt. Paid
Total Miles Walked		Approved			Total Contribution

* Please turn in sponsor money and this form before starting your walk. Make Checks Payable to Blacksburg Host Lions Club.

I release the Blacksburg Host Lions Club from any injuries or damages, which may occur during participation. 

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(Signature of walker. If under 18, signature of parent or guardian.)