Children's Organ Transplant Association

 Proudly Presents 

 COTA 2nd Annual For Rosa Andrews

5K Run ~ 5K Walk

Pledge

                                   

           April 25, 2010 ~ 8:00 a.m. ~ Registration Starts @ 7:00 a.m.

At Kiwanis Park ~ Tempe, AZ

(Baseline Entrance Between Mill & Kyrene)

 

Mail in Registration Form

 

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

with CHECK, made payable to: COTA

With (In honor of Rosa Andrews) on the memo line.

Mail to: Arizona RunningEvents Co. (ARC)
1963 E. Kentucky Ln ~ Tempe, AZ 85284

 

Last Name:   
First Name:

Address:    
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   Youth  Size:  YM

 

COTA is a national charity that is dedicated to organizing and guiding communities in raising funds for transplant patients.  In Phoenix an estimated $75,000 is being raised by volunteers.  All proceeds will help

 pay transplant related expenses. 

 

PRICING

Category

Early Entry

postmarked by

3/25/10

Registration

after

4/15/10

 Race Day

Fill in Amount

5K Run

$20.00

 $25.00 $30.00

5K Walk

$20.00

$25.00

 $30.00

 Additional Donation to COTA        (Optional)   

 


TOTAL

  


  Check #    

 

                                                        Pledge Form Optional

Name Address Phone Pledge Paid
         
         
         
         
         

 

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.

WAIVER:  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 city of Tempe, COTA,  Arizona RunningEvents Co., 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)__________________________________________