Online Registration

Leadership Porterville Mud Run 2012

Online Registration is now Closed.
   

 
   

     

PRICES:
Before August 1, 2012 (T-Shirts not guaranteed if registered July 27, 2012 or later):
$100 per team
$25 per individual (if you can’t find a team of five)
$10 per kid (No t-shirt included for kids run) – will have awards and raffle

NO RACE DAY REGISTRATION!

IMPORTANT NOTE FOR INDIVIDUALS:
The Mudrun is a TEAM COMPETITION ONLY.
If you cannot find 5 team members then Leadership Porterville will try to match up individuals to complete a team of five.
Please fill out the Registration Form for as many participants as you can find.
If Leadership Porterville is unable to fill out your team, your partial team may still participate but will be ineligible for awards.

                Register Online Below                    Additional Information at www.portervillemudrun.com

     
       

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 6% will be added to the registration fee. The processing fee for the Kid's MudRun is $1.00
   
 
                   
PORTERVILLE MUDRUN
   
              Categories:  

           Team Name:

  Business Sponsor:   BUSINESS SPONSORING THE TEAM (if any)

Select One Of The Following:  Team Captain  Individual  Child

   Registration Fee:     

                     Name:

                 Address:

  Cell/Home Phone:

  Cell/Work Phone:

        Date of Birth:

                  Gender:     

Emergency Phone:

      Email Address:

               Shirt Size:


Team Member #2

                    Name:

                 Address:

  Cell/Home Phone:

  Cell/Work Phone:

        Date of Birth:

                  Gender:

Emergency Phone:

      Email Address:

               Shirt Size:

Team Member #3

                    Name:

                 Address:

  Cell/Home Phone:

  Cell/Work Phone:

        Date of Birth:

                  Gender:

Emergency Phone:

      Email Address:

               Shirt Size:

Team Member #4

                    Name:

                 Address:

  Cell/Home Phone:

  Cell/Work Phone:

        Date of Birth:

                  Gender:

Emergency Phone:

      Email Address:

               Shirt Size:

Team Member #5

                    Name:

                 Address:

  Cell/Home Phone:

  Cell/Work Phone:

        Date of Birth:

                  Gender:

Emergency Phone:

      Email Address:

               Shirt Size:

Print Waiver Below

Waiver:        I understand that the release must be signed by each Team member and returned prior to participating in the Event. Print out and bring the signed waiver to pre-registration or to the race. You must have the form completed and turned in prior to event start.

WAIVER AND RELEASE OF LIABILITY KIDS.pdf            WAIVER AND RELEASE OF LIABILITY ADULTS.pdf


   
 

Online Registration is now Closed.
   
Online Payments
   
          
   

   

For More Information Contact garydsmith@runwalkjog.com    Privacy Policy