Registration-TEST

Published on: August 28, 2016

Registration form

Email:

First Name:

Last Name:

Gender:

Male Female

Event:

– select race or walk – 5k Run Mile Walk

5k race fee is $25, Mile walk is $10.
USATF-NJ Members will be given a $3 race discount for pre-registration. If applicable, please enter your USATF-NJ number below.

USATF Number:

You can run as a part of a team. Coworkers, schoolmates, families or anybody else can form a team!

Team Name:

If registering for the 5k Run, please choose your T-shirt size

T-Shirt Size:

Small Medium Large X-Large

Phone Number:

Address:

City:

State:

NJ

Zip Code:

Select Age on Event Day:

– select age – 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

Promo code:

Waiver: By submitting this form, I acknowledge that participation in the Legwork for Lungs 5k and Mile Walk involves a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge the Legwork for Lung Team and its affiliates, sponsors, agents, Bernards Township, and any other company/organization contributing to this event and representatives, of and from any and all liability for injury, death, or damages and/or any other claims, demands, losses or damages, incurred by me in connection with any aspect of the 5k run and walk. I hereby grant full permission to use any photographs or any other record of this event for legitimate purposes.

Submit and Pay