Registration

REGISTRATION

First Name
Last Name
Street Address
City
State
Zip
Phone
Email
Age on Race Day
Date of Birth
Gender
Select Race
Shirt Size:

Race entry fee ($20.00) is due on race day.

In submitting this form, I am electronically signing it and I assume all responsibility and agree to waive any responsibility for the organizers of the Rick Haschel Memorial 5k, Winamac Athletic Boosters and all other sponsors for any injury incurred during said race. I verify that I am physically fit and have sufficiently for this event.