Mail In Application

6th Annual
Race to Beat Breast Cancer
5K and 10K
Hosted by Harrisonburg Parks and Recreation.

Saturday October 25, 2008 @ 8:45AM (Registration Cutoff)

9:00 to 9:25 Introductions and Cancer Survival Testimonial

                                 9:30 5K & 10K Run

                                 9:35 5K Walk                                  

(All proceeds go to RMH Breast Cancer treatment)

Registration: Early Registration begins on April 1, 2008 and ends on October 17, 2008.  Registration forms and fees can be dropped off or mailed to the: Harrisonburg Department of Parks and Recreation: 305 South Dogwood Drive: Harrisonburg, VA 22801.

Attn: Erik Dart. (540) 433-2474

MAKE CHECKS PAYABLE TO: RMH CANCER CENTER.

**Registration is not complete until payment is received**

Entry Fee: Early Registration ends on October 17, 2008.  Fee of $15

                 Late Registration/ Race Day Registration:  $20

*$10 per person for special groups/teams, i.e. clubs, sports, fraternities, sororities, etc.*

Registration Form

Name/Group: _______________________________ Sex: _______ Age: _____

Address: ________________________________ City: _____________ State: _____ Zip: ______ Home Phone: (____) _____-______ Work Phone:  (____) ____-______

Email: ________________________T-shirt Size: ______ Runner_____ Walker______

Waiver:  I hereby release the City of Harrisonburg, its employees, and volunteers 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 any program or in any facility or at any location where this program is held.

Signature: ___________________________________ Date:__________                   (Parents Signature required if under 18.)