RoadDawg5K
"Doing It For Keith"
First Name:
Last Name:
Street Address Apt. #:
City:
State:
Zip Code:
Phone Number:
Age:
Birth Date:
Gender (Type Male or Female):
Email Address:
By hitting the submit button I am confirming
that the information stated above is true
and that I agree to all the terms and
conditions set forth.
RELEASE: In consideration of the acceptance of this entry to the RoadDawg5K Run/Walk, I waive all claims for myself, my heirs and assigns against all sponsors, promoters, event officials and all others associated with the organization and facilitation of this event for any injury and/or illness which results from my participation. I further state that I am in the proper physical condition to participate in this event. I also authorize the use of my name and/or photograph taken at this event for use in any promotion or news media release without compensation.
Upon submission of this form you will be
redirected to the donate page where you can
use your credit card for payment.
