Registration Form

First Name:  

Last Name:  

     Address:  

            City:  

          State:  

             Zip:  

           Age:  

            Sex: Choose One Male Female

   Phone:  

   Email:  

Check the boxes for each category you plan to participate in.
You will be charged an entry fee for each category you plan to participate in.

Adult

Just For Fun Mile Adult
Mile Run Adult
Elite Mile  39 and Under (qualifying times: Men 4:40 / Women 5:30)
Elite Mile 40+ (qualifying times: Men 5:00 / Women 6:00)

Child 

Just For Fun Mile Child  12 years or younger
Mile Run Child  12 years or younger
Half Pint Half Mile Must be 6 years or younger

Waiver:

In consideration of the acceptance of this entry to the Harrisburg Mile, I waive all claims for myself, my heirs and assigns, the sponsors, cooperating and coordinating groups, and any individuals associated with the event, and will hold them harmless for any and all injuries that may result from my participation. I further state that I am in proper physical condition to participate in this race. I also give my permission to the media to use my name and/or picture in any newspaper, broadcast, telecast or other account of this event, without limitation and obligation to anyone to compensate me further therefore.

Select Yes I Agree With The Above Waiver.

Select yes if you understand and agree with the above waiver.  You must agree with the waiver in order to participate in this event.

Electronic Signature
Please Type In Your Name:             

Must Be Signed By Parent Or Guardian If Under 18 Years Of Age