Last Name:  

           First Name:  

                Address:  

                       City:  

                     State:  

                         Zip:  

                    Phone:  

                     Email:  

                   Gender: Choose One Male Female

Age On Race Day:  

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

Minimum of 8 for $2 per person group discount (teams, businesses, clubs etc.)

Group Name:

In consideration of being permitted to participate in the Coaches vs. Cancer 5K Run/Walk, I hereby for myself, my heir, and personal representatives assume any and all risks which might be associated with the event and I further waive, release and covenant not to sue the Pennsylvania State University, the American Cancer Society, its officers, members, sponsors, organizers, or representatives, or successors, and assigns for any injuries or damages of any kind whatsoever suffered in result of taking part in the event and related activities.

   Agree To Waiver: Choose One Yes I Agree You Must Agree With Waiver And Provide Signature To Participate.

 Signature (Required For All Participants):                           

Signature above must be signed by parent or guardian if under 18

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Running In Memory Or Celebration Of:  

Online Registration Is Now Closed