Individual Registration

Porterville Breakfast Rotary Club
Cancer 5K Run/Walk

Saturday, May 1, 2010
Granite Hills High School - Event starts at 8:00 A.M. Sharp!

Online Registration Is Now Closed
   

Pre-Registration Fees: Closes 4/26/10

Adults: $20.00 Youth (12 & under) $15 Seniors (60 & over) $15

Race Day: Adults: $30.00 Youth (12 & under) $25 Seniors (60 & over) $25

Day of Race Registration: 6:30 A.M. - 7:30 A.M. (Can not guarantee T-shirt with Day of Race Registration)
  

Please Enter Participants Information and click below to proceed to a secure credit card processing page. To register more than one participant select the "Add Additional Registration" option after submitting each registration or just click on the "Back Button" in Your Browser to return to this page.

Please notify garydsmith@runwalkjog.com if you experience problems with online registration.  For online registration a processing fee of $1.25 will be added to the registration fee for each participant.

 
Porterville cancer 5k run


                                   First Name:  

                                    Last Name:  

                                         Address:  

                                                City:  

                                              State:  

                                                  Zip:  

                                             Phone:  

                                              Email:  

Walking Or Running In Honor Of:  

                         Age On Race Day:  

                                            Gender:
 

                                               Event:
 

                                             T-Shirt:
 

                                                  Fee:


Full Waiver and Release: In consideration for my entry being accepted, I hereby waive and release forever for myself and for my heirs, executors, administrators, any and all claims, causes of actions and suits I may accrue against the Porterville Breakfast Rotary Club, City of Porterville, County of Tulare, property owners on whose property the race is run, race director, volunteers and any sponsors of this race for any bodily injury, emotional injury, property damage or economic loss, including death suffered by me while traveling to and from or competing in the Porterville Cancer 5K Run and/or 5K walk or Short Walk, on May 1, 2010 whether from natural hazards, human-made hazards or any other defect or omission or act. *Any participant under age 18 must have parental approval to participate.

                                            Waiver: You Must Agree With Waiver In Order To Participate.
 

                                       Signature:  

Parent or Guardian For Minor (I am representing that I have the Authority to sign this release)  sign below

                                        Guardian:

Online Registration Is Now Closed

 
   
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