Run for the Islands Mail-In Registration Form

Run for the Islands 5K and Beach Party

Please fill-out, print and sign the form. Please fill out one form for each entry.
Make check payable to Islands Elementary School PTA. Mail to:
CCMC8360 E. Via de Ventura, #L-100

Scottsdale, AZ 85258-7564

Please note: a signed registration form is REQUIRED for EACH participant.

Online registration available by clicking here!

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 100-Yard Dash | Adult T-Shirt Size: S M L XL

PRICING

Category	Early Entry (postmarked by 1/17/07)	Entry postmarked after 1/17/07)	Race-Day Entry	Fill in Amount
5K Walk/Run Entry Fee (includes beach party)	$15.00	$20.00	$20.00
100-Yard Dash Entry Fee (includes beach party)	$5.00	$5.00	$5.00
Additional Beach Party Tickets (Ages 11 and Up): # @ $5.00 =
Additional Beach Party Tickets (Ages 10 & Under): # @ $0.00 = Please note: Each participant in ANY running event must have his own registration form AND signed waiver. Additional forms may be attached to this one when mailed.
	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 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 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)__________________________________________