2006 Grant Wheeler Memorial 5K Walk/Run Registration Form

Please fill out all the information then click the Submit button at the bottom of the form. Your registration will not be recorded unless the Submit button is clicked.

The registration information is recorded in our secure database and is automatically added to the race roster. This information is used for this race and this race only. Information collected here is confidential and is not sold, bartered or distributed in any way. Fees must be paid at registration to pick up your race packet. This form may also be printed and mailed to:

Grant Wheeler Memorial 5K Run/Walk

c/o Don Williams
2907 Dallas Dr.
Cedar Falls, IA 50613

Release:

Knowingly and at my own risk, I hereby agree to run the Grant Wheeler Memorial 5K and agree to release any claims for damages or injuries that may incur as a result of my participation against the Cedar River Runners Club, Orchard Hill Church, or any volunteers or sponsors assisting with the race. I further hereby certify that I have full knowledge of the risks involved with running and am physically fit and in sufficient condition to participate.

Fees:

Entry Fee is $18. You may also make a tax deductible contribution to the Grant Wheeler Memorial Fund. Checks should be made payable to: Community Foundation - Grant Wheeler Memorial Fund.

First Name:

Last Name:

Address:

City:

State:

Zip:

Gender:

Male

Female

T-Shirt Size

Adult

Small Medium

Large XLarge

XXLarge (Add $2.00)

Kids

Small Medium Large

T-Shirt not guaranteed for race day registration.

Age:

As of October 21, 2006