Remember 911 5K Run & Fun Walk

September 12, 2009

Kiwanis Park ~ Tempe, AZ 

      (Sister City Garden area on All American Way)

Registration Starts @ 5:30 a.m. - Races Start @ 6:45 a.m.

 

Mail-In Registration Form

Please fill-out, print and sign the form. Please fill out one form for each entry.
Make check payable to & Mail to:  Arizona RunningEvents Co. (ARC)

                                                                     5290 W. Melinda Lane   

                                                              Glendale, AZ  85308

 

This event will benefit
 

Last Name:   
First Name:

Address:    
Apt./Suite: 

City:             State: Zip:

Phone:                Date of Birth:

Age on Race Day:       Email Address:

Gender: male    female

 

Event:  5K Run 5K Walk  

Adult T-Shirt Size: XL  

 

PRICING

Category

Early Entry
(Postmarked through Septemver 2, 2009

Entry
(After

September 2, 2009

 

Day-Of Event

Fill in Amount

5K Run or 5K Walk

$18.00

$20.00

$25.00

Active or Retired US Military - Police or Fire 5K Run or Walk

$15.00

$15.00

$20.00

 

Children's Dash Free            ~                Cost for t-shirt        $5.00  
 


TOTAL


    Check #  

 

Please read the waiver and sign the form. Thank You.
RELEASE FORM (MANDATORY): All applications MUST be signed to enter this event. No entry accepted without fee. NO REFUNDS.
In consideration of accepting this entry, I the undersigned, intending to be legally bound hereby, for myself my heirs, executors, and administrators waive and release any and all rights and claims for damages I may have against the Arizona RunningEvents Co., USAT&F, City of Tempe or anyone associated with this event, their representatives, successors and assigns for any and all injuries suffered by me in said event.  I will additionally permit the free use of my name and pictures in broadcasts, telecasts, newspapers, etc.

 

Signature:____________________________________________________________Date:________________
 

Parents signature (if under 18 years of age) & DATE)__________________________________________