Registration

Up to 10 participants may be entered at one time.

Quantity
Price
Total
5K Run
X
$
35.00=
$
0

5K Walk
X
$
25.00=
$
0

1 Mile Fun Walk
X
$
15.00=
$
0

Final Total:
$
0

Please be sure that the quantity you have purchased above matches your race type selections below for your participants.

Participant Information


Participant 1

First Name
Last Name
Date of Birth

Participant 2

First Name
Last Name
Date of Birth

Participant 3

First Name
Last Name
Date of Birth

Participant 4

First Name
Last Name
Date of Birth

Participant 5

First Name
Last Name
Date of Birth

Participant 6

First Name
Last Name
Date of Birth

Participant 7

First Name
Last Name
Date of Birth

Participant 8

First Name
Last Name
Date of Birth

Participant 9

First Name
Last Name
Date of Birth

Participant 10

First Name
Last Name
Date of Birth

Group/Team

If your participants will be part of a team, please enter the team name here.

Once your registration is complete, you will receive a confirmation email containing a link to create an individual supporter page, if you choose. Then you can go on to create or join a team page.

Team Name

Pretty in Pink Contest

Be sure to wear your most creative pink outfit and accessories for a chance to win a prize! Enter the name(s) of the participants wishing to enter the Pretty in Pink Contest below.

Pretty in Pink Contest Participants

Waiver and Photo/Video Release

I understand that participating in this event is potentially hazardous, and that I/participants should not enter and participate unless I/we are medically able and properly trained. In consideration of the acceptance of this entry, I/we assume full and complete responsibility for any injury or accident which may occur while I/we am traveling to or from the event, during the event, or while I/we are on the premises of the event. I/we are also aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic and conditions of the road. I/we, for myself and my heirs and executors, hereby waive, release and forever discharge the event organizers, sponsors, promoters and each of their agents, representatives, successors and assignees and all other persons associated with the event, for all my liabilities, claims, actions or damages that I may have against them arising out of or in any way connected with my participation in this event. I/we understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties or otherwise.

 

In addition, I/we authorize Goshen Health and Middlebury Walks for a Cure to release or use photographs or video recordings that I/we may be included in as a participant at the event. These photographs/recordings may be used for promotional purposes of the event or otherwise in the future.

 

Please type your name below. This will serve as an electronic signature for yourself and those you've listed as participants.

Signature

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

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