911 5K Mail-In registration form

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: S M L 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)__________________________________________