Please enable JavaScript in your browser to complete this form.General InformationFirst Name *Last Name *Checkboxes *MaleFemaleAddress *City *Select State *Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *Phone Number *Email *Race Information Race Particaipation *In-PersonVirtualPlease check one event: *5K Walk/Run (in-person at Watkins Regional Park) – $ 35.00Virtual 5k Walk/Run (not in-person at Watkins Regional Park) – $ 35.00T-Shirt size: (t-shirts are unisex) *SMLXL2X3X4X5XEmergency Contact Information Emergency Contact Name: * Emergency Contact Number: *Emergency Contact Relationship: *Release and Race Waiver of liability: (Please check box) *I hereby certify the following:I am physically fit and have medical clearance to participate in the Faith Strong 5k walk/run/virtual on Saturday, September 7, 2024. If I do participate, I, on behalf of myself, my heirs and assigns, and my estate, hereby waive and forever discharge the sponsor, organizers, affiliates, as well as their agents and employees, from all claims that my occur because of my participation. By entering my name below, I assert that I have reviewed and agree to the Release and Race Waiver of Liability that I have selected above. Signature *Type in your full name in the field above.Date *Parent/Guardian Signature, if under age 18Type in your full name in the field above.Total$ 0.00Payment *PayPal CheckoutCredit CardCard NumberExpiration DateSecurity CodeCard Holder NameSubmit Registration * Please note that your registration is not complete until your payment is made and received.
