Online Registration

3rd Annual Victims Awareness 5k Walk/Run

Online Registration Is Now Closed
  

  
NEW THIS YEAR—Invite your family, friends, and co-workers to sponsor you as you walk/run to benefit Safe Haven. Check here for email sponsorship information.
    

Registration Form for Victims Awareness 5k Walk/Run Entry Fee: $10 Pre-Registration includes T T-shirt by July 1st or $10 day of race registration (no T-Shirt) Prizes & giveaways to participants, compliments of our sponsors. Awards for Top Finishers! FREE REFRESHMENTS COMPLIMENTS OF OUR SPONSORS

 "Fast Finisher Management" will be chip timing the 5k.
                             
Mail In Registration Form
                

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.  A $1.00 processing fee will be added for online registration. 
                                  
3rd Annual Victims Awareness 5k Walk/Run
      
             Last Name:


             First Name:


                  Address:


                        City:


                       State:


                           Zip:


                     Gender:


               Birth Date:


  Age On Event Day:


                       Phone:


                        Email:


                         Event:  


                   Shirt Size:

LIABILITY WAIVER:

In consideration of this entry, being accepted, I hereby for myself, heirs, executers and administrators waive and release any claims that I may have against Lackawaxen Township or the organizer of this event or any of the sponsors involved in the Victims Awareness 5K Walk/Run.  I certify that I am Physically able to participate in this event.

  
                                          Waiver:


                                      Signature:


Parent Or Guardian If Under 18:

Online Registration Is Now Closed
  

   
Online Payments
   
          
   

   

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