The 5K Fun RunRegistration Form ENTRY FEE: $25.00 ($15.00 for each additional family member) Please enable JavaScript in your browser to complete this form.Proceeds benefit the Dan Leads Fire & Emergency Services Scholarship.Number of entriesSelect Quantity--123456First Name *Last Name *First Name #2Last Name #2First Name #3Last Name #3First Name #4Last Name #4First Name #5Last Name #5First Name #6Last Name#6Email *Phone *Mailing Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSelect your t-shirt size (s). Unisex Sizes: Small, Medium, Large, X-Large NOTE: Registration must be received before June 4th in order to guarantee a T-Shirt.T-shirt sizeSmallMediumLargeX-largeT-shirt size #2SmallMediumLargeX-largeT-shirt size #3SmallMediumLargeX-largeT-shirt size #4SmallMediumLargeX-largeT-shirt size #5SmallMediumLargeX-largeT-shirt size #6SmallMediumLargeX-largeI know that running/walking a road race is a potentially hazardous activity. I should not and run/walk unless I am medically able and properly trained. I agree to abide by any decision of race officials relative to my ability to safely complete the race. I assume all risks associated with running/walking in this event including, but not limited to falls, contact with other participants, the effects of the weather (including high heat and humidity or elevation), traffic and conditions of the road. Having read this waiver and knowing the facts and consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the organizers and sponsors, their representatives and successors from all claims and liabilities of any kind arising out of my participation in this event even though the liability may arise out of my negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the organizers/sponsors of this event to use any photograph, video or any other record of this event for any legitimate purpose. I understand that bicycles, skateboards, roller skates or blades are not allowed in the race and I will abide by this rule.Electronic Signature (Type Name) *Signature (sign with finger or mouse) *Clear SignatureTotal Amount (USD)$ 0.00CommentPay Now NOTE: This form will open a window where you can pay with your PayPal account or Checkout As A Guest & pay with your Credit Card.