*Last Name:

*Age:

*Sex:
     Male
     Female

*Mailing Address:

*City:

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*Zip Code:

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*Phone:

*T-Shirt Size (Adult sizes only):
     Small
     Medium
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*Participating in:
     5k Run
     5k Walk
     I want to help the cause and get a t-shirt, but I won't be running or walking the event
     I want to put more money toward a good cause. I won't be participating in the event and do not need a t-shirt

Referred by (person or place):

RULES: Stay on the course. No animals in the race or at the start or finish area.

5K Run For Your Life is a Southern Arizona Roadrunner Good Neighbor Race.

www.azroadrunners.org

The Southern Arizona Roadrunners is a not-for-profit organization dedicated to promoting health and fitness in Tucson and Southern Arizona through running and walking.

WAIVER: I understand that participation in "Run for Your Life" presented by SHAC may involve strenuous physical activity, which carries risks of injury and illness. I understand that it is advisable to consult with my personal physician before participating in such activity. In consideration of your accepting my entry, I, intending to be legally bound for myself, my heirs, executors and administrators, acknowledge that I have made my own investigation and that I am on notice of, assume, and accept those risks. To the maximum extent permitted by law, I release the University of Arizona/Arizona Board of Regents, the Student Health Advisory Committee part of ASUA, Southern Arizona Roadrunners, and all other individuals and organizations sponsoring, promoting, organizing, or participating in "Run for Your Life" from liability for any illness, injury or other damages or harm I may suffer as a result of participating in this program. Also, none of the above are responsible for the loss of personal items nor any other form of aggravation in connection with said event. I also give permission for the free use of my name and picture in any broadcast, telecast, or print media account of the event. I understand that all participants must obey the lawful order of a police officer or coordinators. In submitting below this form, I acknowledge I have read and fully understand my own liability and do accept the restrictions. I represent and certify that I am over 18 years of age or have the consent of my parent or legal guardian; that I am in appropriate physical condition to participate in this program; and that I have carefully read this Acknowledgement and Waiver, understand its contents, and agree to it of my own free will.

By checking this box, I agree to the above waiver

Please type your full name in the box below. This is equivalent to your legal signature.



* indicates required field

**$15 early registration fee through Friday, March 23rd.
**$20 registration beginning Saturday, March 24th.