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 $15 per person group discount (teams, businesses, clubs etc.) Team members must register separately.

Group Name:

        Gender: Select Female Male

T-Shirt Size:   Select One Small Medium Large X Large XX Large

Waiver: : I hereby release the City of Harrisonburg, its employees and volunteers, as well as any other organization associated with this event including Gamma Sigma Sigma, Circle K and FIJI, Shenandoah Valley Autism Partnership, and Eastern Mennonite University from all claims for damages arising from any accident or injury, which are caused or arise from the participation of the above name applicant during the Harrisonburg 5K Walk/Run at any facility or at any location that the program is held .

Agree With Waiver: Select Yes

    Participant Signature:   (Parents Signature required if under 18)

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