Optimism Rum For Parkinson's Disease

   5K Run/Walk & 1 K Fun Run/Walk

 April 15, 2012

   Midwestern University ~ 19555 N 59th Ave ~ Glendale, AZ

1 K Start 9:00 am ~ 5K Start 9:30 am

Registration Starts @ 8:00 am

  

    This event will benefit the American Parkinson's Disease Association.

Please NO Pets ~ NO Strollers

                         

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

                                                  American Parkinson's Disease Association

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

                                                                Registration Form

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 1 K Fun Run/Walk 

 

Adult T-Shirt Size: S  M  L  XL    XXL

If you are a person racing with Parkinson's Disease please check here to

receive a special shirt

 PRICING

Category

Early Entry
(postmarked by 04/08/12)

Entry

(postmarked after 04/08/12)


Day-Of Event
 

Fill in Amount

5K Run/Walk

$25.00

 $30.00

$35.00

1-K Fun Run/Walk

$20.00

 $20.00

$20.00


 

  


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, City of Glendale,

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)__________________________________________