2nd Annual Mountain Park Health Center More Than a Race

      5K Run/Walk & 1K Fun Run/Walk

  April 28, 2012

Races Start 7:00am

Registration Starts @ 6:00am

 

MPHC Goodyear Clinic ~ 140 N Litchfield Rd. ~ Goodyear, AZ 85338

For more Information Please call Deborah @ (602) 323-3411

 

  

 Registration Form

 After filling in the fields below, please print and mail registration form WITH CHECK made payable to:   

                                                   Mountain Park Health Center Foundation           

               Mail to: All Arizona Running Events (AARE) ~  5290 W. Melinda Ln. ~ Glendale, AZ 85308

                                                           

Last Name:  
First Name:

Address:   
City:              State: Zip:

Phone:         Date of Birth:

Age on Race Day: Email Address:

Gender: male    female

 

Event:  5K Run/Walk 1K Fun Run/Walk 

 

Adult T-Shirt Size: S  M  L  XL  XXL

 

  PRICING

Category

Early Entry
(postmarked by 04/25/12)

Entry

(postmarked after 04/25/11)


Day-Of Event
 

Fill in Amount

5K Run

$25.00

 $30.00

$30.00

1K Fun Run/Walk

$25.00

 $30.00

$30.00

                             


 

  


TOTAL


    Check #

Please read the waiver and sign the form. Thank You.
RELEASE FORM (MANDATORY): All applications MUST be signed to enter this event. No entry accepted without fee. NO REFUNDS.
 In consideration of your acceptance of this entry, I, the undersigned, hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the All Arizona Running Events Company, Mountain Park Health Center Foundation Inc and its Officers and Directors, USATF, City of Goodyear. or sponsors, coordinating groups, and any individuals associated with the event, and their representatives, successors, officers, agents, and assigns, for any and all injuries sustained and suffered by me during this race. I verify that I am physically fit and have sufficiently trained for competition of this event.. I will permit the free use of my name and hereby grant full permission to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purpose. I understand that the entry fee is non-refundable. I have read the foregoing and certify my agreement by my signature below.

 

Signature:____________________________________________________________Date:________________
 

Parents signature (if under 18 years of age) & DATE)__________________________________________