Aviano Family 5K Run/Walk      

                                                March 13, 2010

                                            Aviano Clubhouse

                      22500 N Aviano Way ~ Phoenix, AZ ~ 85050 

                          

                       Registration Starts 7:00 a.m.  Race starts at 8:00 a.m.

 

                      After filling in fields below, please print registration form and mail

                                                       With Check  Made Payable TO: Aviano

                                                       To: Arizona RunningEvents Co. (ARC)

                                                       5290 W. Melinda Ln.

                                                       Glendale, AZ 85308

                                                                   Or

                             Walk In Registration @ The Aviano Community Association

                                         22500 N. Aviano Way ~ Phoenix , AZ  85050

                                This Event will Benefit Hope for Haiti

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/Walk

 

Adult T-Shirt Size: S  M  L  XL  ~  Youth Med

 

             PRICING

Category

Early Entry
(postmarked by 03/0510)

Entry

(postmarked after 03/05/10)


Day-Of

Event
 

Fill in Amount

5K Run/Walk

$15.00

 $20.00

$25.00

 Optional Donation ~ Hope for Haiti  
 Total
 Free Kids Dash ~  Please Register Children
    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 your acceptance of this entry, I, the undersigned, 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 Company, Aviano Community Association, Carefree Events, City of Phoenix, sponsors, coordinating groups, and any individuals associated with the event, and their representatives, successors, officers, agents, and assigns, for any and all injuries sustained and suffered by me during this race. I verify that I am physically fit and have sufficiently trained for competition of this event and my physical condition has been verified by a licensed medical doctor. I will permit the free use of my name and hereby grant full permission to use any photographs, videotapes, motion pictures, recordings or any other record of this event for any legitimate purpose. I understand that the entry fee is non-refundable and numbers are not transferable. I have read the foregoing and certify my agreement by my signature below.

 

Signature:____________________________________________________________Date:________________
 

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