The Rim Country Challenge

October 4, 2008

1/2 Marathon - 5K & Youth Athlete's Mail-In Registration Form

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

5290 W. Melinda Lane

Glendale, AZ 85308

 

Location: Green Valley Park Payson, AZ

Start Times: 1/2 Marathon & Relay 8:00 AM ~ 5K 8:15 AM ~ Young Athletes Fun Run/Walk 9:00 a.m.

For more information please visit www.rimcountrychallenge.com

 

This event will benefit Payson Area Habitat for Humanity (PAHH)

Last Name:   
First Name:

Address:     Apt./Suite:  

City:             State:     Zip:

Phone:         Date of Birth:    Age on Race Day:

Email Address:

 

Gender: male    female

 

Event:  1/2 Marathon  5K  Young Athlete's Fun Run 1/2 Marathon Relay Team 

 

Adult T-Shirt Size:   S   M  L  XL  

 

FEES:

Category

Early Entry
Postmarked through
9/26/2008


Entry Fee
(after 9/ 26/2008)
 

Fill in Amount

1/2 Marathon

$40.00

$60.00

Four Person  1/2 Marathon Relay Team

$120.00

$140.00

5K Run/Walk

$20.00

$40.00

 Youth Athlete's Fun Run $10.00 $10.00     

Tax Deductible Donation  (PAHH)

(Optional)

 Total

 

 

Please fill out information below if signing up for a Relay Team.

 

TEAM NAME:   

 

Name:   Age:   Gender:   male  female  T-Shirt Size:__

Name:   Age:   Gender:   male  female  T-Shirt Size:__

Name:   Age:   Gender:   male  female  T-Shirt Size:__

Name:   Age:   Gender:   male  female  T-Shirt Size:

All team members must sign the waiver below.

 

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 Arizona RunningEvents Co., City of Payson, Mazatzal Casino, Payson Area Habitat for Humanity 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)__________________________________________

 

Signature:____________________________________________________________Date:________________

 

Signature:____________________________________________________________Date:________________

 

Signature:____________________________________________________________Date:________________