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Coach Karen Brown
Offline Printable Registration & Consent Form click here.
TEAM JERSEY FEE $10.00
RACE FEE $24.00
TEAM FEE $30.00
* First Name
* Last name
Do you receive texts
* Email Address
Age (as of Dec. 31 of current year)
* USATF Membership Number
EMERGENCY CONTACT INFORMATION - FIRST NAME
EMERGENCY INFORMATION: (any medical issues including allergies)
If ordering a team singlet, please inform us of the size needed.
* An online processing fee of 5.4% will be added to the total to cover paypal charges.
I acknowledge that I have read the "Parental Consent For Treatment Of Child" and the "Hold Harmless Agreement" and the "Consent To Sign Entry/Waiver Forms" as described at www.hartbeatrunningclub.webs.com
ACKNOWLEDGED "PARENTAL CONSENT FOR TREATMENT OF CHILD".
ACKNOWLEDGED "HOLD HARMLESS AGREEMENT".
ACKNOWLEDGED "CONSENT TO SIGN ENTRY/WAIVER FORMS".
Thank you for registering. We will get back to you as soon as possible. If paying by PayPal click on PayPal button below.
Hart Beat Running Club
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TEAM JERSEY FEE