Veteran's Day 5K Registration

Veteran's Day 5K Registration
Race Date: November 13, 2021

Location: UBTech Vernal Campus at 450 N 2000 W, Aggie Blvd, Vernal, UT 84078

Registration: 7:30 AM

Flag Ceremony: 8:00 AM

Race Starts Promptly after Flag Ceremony: 8:15 AM

Free Community Breakfast (open to everyone): 8:30 - 10:30 AM
Participant Information
Participate #1 Full Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Proceeds go towards
UBTech Veteran Scholarships!
Shirts are unisex long sleeve 50/50 cotton/polyester blend

Veterans can receive a free shirt at the day of the event while supplies last
Participant #1 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #1 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #2 Full Name

First NameLast Name
Participate #2 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #2 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #3 Full Name

First NameLast Name
Participate #3 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #3 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #4 Full Name

First NameLast Name
Participate #4 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #4 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #5 Full Name

First NameLast Name
Participate #5 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #5 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #6 Full Name

First NameLast Name
Participate #6 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #6 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #7 Full Name

First NameLast Name
Participate #7 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #7 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #8 Full Name

First NameLast Name
Participate #8 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #8 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #9 Full Name

First NameLast Name
Participate #9 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #9 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
I have additional participants I want to register

YesNo
Participant #10 Full Name

First NameLast Name
Participate #10 Package:

$40+ donation: long sleeve shirt, medal, registration fee$25+ donation: medal, registration fee$10+ donation: registration fee
Participant #10 Shirt size (unisex) (requires a $40 or more donation per shirt)

SMLXLXXLXXXL
Emergency Contact Details
Contact Person

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Payment Information
Costs:
$40+ includes shirt, medal and registration (per participant). $25+ donation includes medal and registration (per participant). Minimum $10+ donation includes entrance fee (per participant). Proceeds will go towards the UBTech veteran scholarships!
Method of Payment

Total Payment:

USDEnter Your Costs + Additional Donations = Total Payment

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Donation Thermometer
Waiver & Release
I acknowledge that this race requires physical activity and there are possible risks and danger.
Participant's Signature

Clear
Date Signed

MonthDayYear
Date
Parent/Guardian Signature (if participant/s is/are below 18 years old)

Clear
Date

MonthDayYear
Date
Should be Empty:

Veteran's Day 5K Registration

Participant Information

Emergency Contact Details

Payment Information

Waiver & Release