First Name:

        Address:

               City:

             State:

                Zip:

            Email:

           Phone:

Age On Race Day:

            Event:             Select Event 5K Run 5K Walk 5K Run Group Discount 5K Walk Group Discount For group discount select 5k run or walk group discount.

Minimum of 5 for $10 per person group discount (teams, businesses, clubs etc.)

Group Name:

Waiver: I hereby release the City of Harrisonburg, it's employees, and volunteers, as well as any other organizations associated with the event including Gamma Sigma Sigma, Circle K International and the Shenandoah Valley Track Club,  from all claims for damages arising from any accidents or injury which are caused by or arise from the participation of the above name applicant during the Harrisonburg 5K Run / Walk for Autism and at any facility or at any location where the program is held.

Agree With Waiver: Select Yes

     Signature:               (Parents Signature required if under 18)

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.

Mail In And Online Registration  Is Now Closed.  There Will Be Race Day Registration At the Event Site From 7:30 A.M. - 8:30 A.M.