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Saturday June 17, 2017

9:00 a.m.

Brookside Community Club

Mendham Twp. , NJ

Please select from the following categories:

5K Run		$27.00
Kids' Fun Run		$10.00
5K - USATF-NJ	Must be a valid 2017 USATF-NJ member to receive discount.	$24.00
Add a $25 donation (Friend)	Support the playground fund with a direct donation in addition to your event registration fee.	$25.00
Add a $50 donation (Partner)	Support the playground fund with a direct donation in addition to your event registration fee.	$50.00
Add a $100 donation (Supporter)	Support the playground fund with a direct donation in addition to your event registration fee.	$100.00
Add a $200 Donation (Booster)	Support the playground fund with a direct donation in addition to your event registration fee.	$200.00
Add a $500 donation (Cheerleader)	Support the playground fund with a direct donation in addition to your event registration fee.	$500.00

Please provide the following information on the participant. Required fields are denoted by an asterisk *.

*First Name

*Last Name

*Gender

*Birth Date

YYYY

*Address

Address

*City

*State

*Zip

County

*Country

*Phone

*E-mail

A registration confirmation will be sent to this e-mail address


Waiver	In consideration of this entry being accepted, I hereby for myself, heirs, executors, and administrators waive and release any claims against the Mendham Twp. Recreation Commission, staffs, officers, directors, USA Track & Field, Sports Action Reaction LLC, and any and all Parties, Groups, Organizations, Volunteers, Sponsors, and (or) any Representatives involved in Patriots' 5K/8K Race for any and all injuries suffered by me in this event. And I grant the right to use my likeness in any photographic record of the Patriots’ Events. I further attest that I am medically and physically able to participate in said event.
* I have read the above waiver and agree to terms

*Please choose your T-Shirt size:

YM YL S M L XL

2017 USATF-NJ membership # (for discount and Grand Prix)

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