Online Registration

2012 Harrisonburg 5K Walk/Run for Autism

        

Harrisonburg
5K Walk/Run for Autism


Saturday April 21, 2012
University Commons at Eastern
Mennonite University

Online Registration Is Now Closed

 

  

Hosted by JMUs Gamma Sigma Sigma, Circle K and FIJI
with Shenandoah Valley Autism Partnership

Proceeds will benefit the Shenandoah Valley Autism Partnership

  
    
Entry Fees: Early Registration: Before March 30th

Late Registration: After March 30th

5K Run $20 $25
5K Walk $20 $25
5K Run (Group Discount) $15 $15
5K Walk (Group Discount) $15 $15
             Minimum of 5 for $15 per person group discount (teams, businesses, clubs etc.)                                        
     
Donation Form     Mail In Registration Form     Online Registration     Course Map.pdf
   

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 $1.75 will be added to the registration fee for each participant.  This fee will be $1.25 for participants with group discount.

      

2012 Harrisonburg 5K Walk Run for Autism
 
   Last Name:


   First Name:


        Address:


               City:


             State:


                Zip:


            Email:


           Phone:


Age On Race Day:

                     Event:          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:

T-Shirt Size:  

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:


    Participant 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.

Online Registration Is Now Closed

   
Online Payments
   
          
   

Acceptance Mark
 

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