Three Miles for Smiles 5K Registration
<font size ="4">
<b><center> Event:  Sunday, October 21, 2012 @ 11AM - 1PM</b>

Please sign in the day of the event at the Penn State Behrend Fields <b>@ 10:30AM</b>. There will be signs indicating where the Registration Area is.  

<i>*By registering for this race, you hereby certify that you are fit and healthy to participate in the Three Miles for Smiles 5K Race.  You waive and release all rights for claims, damages, injury, or suit you may have against Penn State Behrend, and any other officials and sponsors of the 5K run/walk held October 21, 2012 in Erie PA.  If you are unsure of participating, please contact your physician. Thank you! *</i></font></center><p></p>
Sign in to Google to save your progress. Learn more
Full Name *
Phone Number *
(XXX-XXX-XXXX)
Age on Race Day *
Email *
Emergency Contact *
Name
Emergency Contact *
Cell Phone Number
Do you have any medical conditions we should be aware of? *
Required
If Yes, please explain:
T-Shirt Size
Registration *
Choose one:
Payment is due day of the race.  We will have a list of all registered runners.
Please bring cash or make checks payable to PENN STATE UNIVERSITY.
Thank you for helping make one more smile!
~ Omicron Delta Kappa Honor Society at Penn State Behrend
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy