First Name:

                  Address:

                        City:

                       State:

                           Zip:

                     Gender: Choose One Male Female

               Birth Date:

  Age On Event Day:

                       Phone:

                        Email:

                                           Shirt Size: Choose One Small Medium Large X Large XX Large

LIABILITY WAIVER:

Hold Harmless: By participating in the Run for Your Life - Run, I agree to release and hold harmless Manitowoc Sunrise Rotary Club, its officers, directors, employees, and agents, and the City of Manitowoc from any and all liability, losses, claims, actions, costs, including attorney fees resulting from injury to person or damage to property arising out of my participation in the Run for Your Life-Run.  Photograph Authorization: I hereby give Manitowoc Sunrise Rotary Club and its affiliates permission to photograph me during the run and its related activities and to use these photographs for any purpose including but not limited to commercial purpose.  Eligibility Certification:  I certify that in accordance with the rules ot TAC and IAAF governing amateur status, I am eligible to compete in this event.  (No ineligible runner will be allowed to compete)

  
                                          Waiver: Choose One Yes

                                      Signature:

Parent Or Guardian If Under 18:

Online Registration Closed