Register for The Brian Anderson Memorial 5k Run

Washington Twp NJ at Washington Lake Park
May 9, 2010
Race Starts @ 09:00 am

Participant Information

First Name: *
Last Name: *
Address: *
Suite/Floor:
City: *
State: *
ZIP: *
Phone: *
E-mail: *
Gender: *
Birthdate: *

Registration Information

Choose Your Event:

Registration Type: *

Family Registration (Fixed Team) – $40.00
Individual (Individual) – $15.00

T-Shirt:

None
– $ –

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Additional Participants

This team can have up to 5 members. You can add the additional members here.

Team Name: *

First Name: *
Last Name: *
Address: *
City: *
State: *
ZIP: *
E-mail: *
Gender: *
Birthdate: *
Choose Your Event:
T-Shirt Choice:
Display in Participant List?	Yes No

First Name: *
Last Name: *
Address: *
City: *
State: *
ZIP: *
E-mail: *
Gender: *
Birthdate: *
Choose Your Event:
T-Shirt Choice:
Display in Participant List?	Yes No

First Name: *
Last Name: *
Address: *
City: *
State: *
ZIP: *
E-mail: *
Gender: *
Birthdate: *
Choose Your Event:
T-Shirt Choice:
Display in Participant List?	Yes No

First Name: *
Last Name: *
Address: *
City: *
State: *
ZIP: *
E-mail: *
Gender: *
Birthdate: *
Choose Your Event:
T-Shirt Choice:
Display in Participant List?	Yes No

Survey Questions

Please take the time to answer these optional questions.

How did you hear about the BA5K?

Did you participate in any prior runs?

Waiver

I know that running is a potentially hazardous activity. I should not enter or run unless I am medically able & properly trained. I also know that there will be traffic, debris, poor footing and other hazards on the course and assume the risk for running on it. I also assume any or all other risks associated with running or attending the race including but not limited to falls, contact with other participants, the affects of the weather, the conditions of the roads and getting lost, all such risks being known and appreciated by me. Knowing these facts, and in consideration of your accepting my entry fee, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge the organizers of this event, all municipalities in which the event is held, all owners of properties through which the race crosses, the race committee, volunteers, runtheday race management, all other organizations directly or indirectly associated with the race, any or all sponsors including their agents, employees, assigns or anyone acting on their behalf, or anyone else associated in any way with this race, from any or all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of , or in the course of, my participation in this event. This waiver extends to all claims of every kind or nature whatsoever; foreseen or unforeseen, known or unknown.

I and all additional participants registered above have read and agree to the waiver above.

You can check out on the next page with a credit card or PayPal.