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Sunday April 3, 2011

9:00 a.m. - 1st event

Stephen R. Gregg Bayonne Park (Hudson County Park)

Bayonne, NJ

Please select from the following categories:

5K Hell-th Run	includes shirt!	$20.00
5K - 2011 USATF-NJ Member	Must provide 2011 USATF-NJ Membership # (shirt included)	$18.00
1M Wellness Walk	includes shirt!	$20.00
Kids Dashes	Watch the kids sprint up to 100 meters! (shirt included)	$5.00

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 I may have against Family Chiropractic Center of Bayonne, Sports A.R. or any and all Parties, Groups, Organizations, Volunteers, Sponsors, and (or) any Representatives involved in Run like Hell-th 5K & 1M Wellness Walk for any and all injuries suffered by me in this event. I certify that I am physically able to compete in this event. I understand that my entry fee is non-refundable.
* I have read the above waiver and agree to terms

*Please choose your T-Shirt size: (YL is same as adult small)

YM YL M L XL

2011 USATF Membership # (must submit if claiming $2 discount)

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