Redemption Way 5k Fun Run
Retro Run. Real Impact.
Participant Information
Full Name
*
First Name
Last Name
Age
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-Shirt Size
*
XS
S
M
L
XL
XXL
Race
*
Please Select
5k
Mile Dash
Additional Participant Information
This section is for additional participant information, if registering for more than one participant.
Full Name
First Name
Last Name
Age
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-Shirt Size
XS
S
M
L
XL
XXL
Race
Please Select
5k
Mile Dash
Full Name
First Name
Last Name
Age
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-Shirt Size
XS
S
M
L
XL
XXL
Race
Please Select
5k
Mile Dash
Are you running with a team?
Please Select
Yes
No
Team Leader
Emergency Contact Details
Contact Person
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Payment Information
My Products
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Registration Fee
$
35.00
Quantity
1
2
3
Additional Donation
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Enter coupon
Apply
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Waiver & Release
I confirm that I am in good shape, health, and condition.
I don't have any medical condition or medical history that will affect my participation in this event
I acknowledge that this fun run requires physical activity and there are possible risks and danger.
I release the fun run event organizers for any responsibility in case of an accident, illness, or injury.
I confirm that all information in this registration form is accurate and true.
Participant's Signature
Date Signed
-
Month
-
Day
Year
Date
Parent/Guardian Signature (If participant is below 18 years old)
Date
-
Month
-
Day
Year
Date
Submit
Submit
Print Form
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