EmailMe Form - Urban Run Off 5K

Urban Run Off 5K

5K fundraiser run/walk March 23,2013 8:00am

Name *
First Last
Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *

Confirm
Phone *
### - ### - ####
Registration Fees:
Check Boxes that apply *
Registration by March 11 $20
Registration by March 21 $30
T-Shirt add $5
No I do not want a T-Shirt
Just Breakfast Please $5
Check One Box *
Female
Male
Check one Box if you are purchasing a T-shirt *
Womens XS
Womens S
Womens M
Womens L
Mens M
Mens L
Mens XL
Disclaimer:
I know that a road race is a potential hazardous activity. I should not enter unless I am medically and properly trained. I hereby for myself, my heirs, executors, administrators, or anyone else who might sue on my behalf, covenant not to sue, and waive, release and discharge the sponsors or cooridinators to this event, any race officials, volunteers, any law enforcement or public officials the Meadows Shopping Center and its owners and tenants from all claims or liability of death, personal injury or property damage of any kind or nature arising out of or in the course of my participation.

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