Singles 5k Registration
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1. Singles' 5K Pre-Registration

This page serves as the registration for the 1st Annual Lake Ward 5K Walk/Run to be held on February 20, 2010, rain or shine. Meet at the Irvine Stake Building located at 23 Lake Rd., Irvine, CA. Registration begins at 8:00 AM. Pre-registered participants should arrive no later than 8:15 AM. Walk/Run begins at 8:30 AM. All information below will remain strictly confidential and only used in the event of an emergency or to send a reminder notice to you of the event. Questions? Contact Leanne at armstrongaz@aol.com

1. Personal Information

Personal Information Name:
Address:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

2. Emergency Contact Information

Emergency Contact Information Name:
Address:
City/Town:
State:
ZIP/Postal Code:
Phone Number:

3. Health Insurance Information (optional)

Health Insurance Information (optional) Insurance Provider
Phone
Group No
ID No

4. I will:

I will: Run

Walk/Jog

Walk

Special accommodations needed (if any):

5. I will bring a healthy snack to share at the "Linger-longer" after the event.

I will bring a healthy snack to share at the "Linger-longer" after the event. Yes

Maybe

6. Agreement: I understand that the 5K Walk/Run (event) is not a race nor a professional event and that I will be required to stay with at least one other person through the entire duration of the Walk/Run. I hereby agree to obey all pedestrian traffic laws while participating in the event. I verify that I am in good health and have adequately prepared myself to participate in the event. I agree to immediately notify a fellow participant or event coordinator if I feel faint, dizzy, or have any other unusual physical feelings or pain and will immediately stop in a safe place until help can arrive. I certify that I have provided correct emergency contact information above and give my permission to the Event Coordinators to contact him/her in an emergency.

Agreement: I understand that the 5K Walk/Run (event) is not a race nor a professional event and that I will be required to stay with at least one other person through the entire duration of the Walk/Run. I hereby agree to obey all pedestrian traffic laws while participating in the event. I verify that I am in good health and have adequately prepared myself to participate in the event. I agree to immediately notify a fellow participant or event coordinator if I feel faint, dizzy, or have any other unusual physical feelings or pain and will immediately stop in a safe place until help can arrive. I certify that I have provided correct emergency contact information above and give my permission to the Event Coordinators to contact him/her in an emergency. Yes

Thank you!

Please review the information you have added and click "Done" to submit your registration.