Registration Form

Name_____________________________________________________

Address____________________________________________________

Phone ______________________ Email ___________________________

How/Where did you hear about the race?________________

Gender: M F Age on race day:_________

In consideration of being permitted to participate in the Coaches vs. Cancer 5K Run/Walk,

I hereby for myself, my heir, and personal representatives assume any and all risks which

might be associated with the event and I further waive, release and covenant not to sue the

Pennsylvania State University, the American Cancer Society, its officers, members,

sponsors, organizers, or representatives, or successors, and assigns for any injuries or

damages of any kind whatsoever suffered in result of taking part in the event and related activities.

_________________________________________________________

Signature                                                                                   Date

_________________________________________________________

Signature of Parent or guardian if under 18                                Date

Registration:
Race day registration will begin at 8:30 a.m. Registration and packet pick-up will be announced later in April. Please go to www.cvcpennstate.org/students.html for updates.

Registration includes:
Race entrance
High quality t-shirts to the first 500 registered participants
All-you-can-eat Spaghetti Dinner for all registered race participants
An extensive selection of refreshments following the race.

Entry fees:
$15.00 for registration
 

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Raffle Ticket

Name_______________________ Phone Number_____________________