Heart and Lung Run Online Registration

Registrant #1

Who are you registering? *

First Name *

Last Name *

Email Address *

Confirm Email *

Create Password *

This will be the password for your SkiSignup account.

Confirm Password *

Date of Birth *

Format: mm/dd/yyyy

Used for age group calculations

Gender *

Male Female

Phone *

Format: ###-###-####

Street Address *

Country *

Zip Code *

City *

State *

Choose Your Event *

5k Run/Walk - Children Aged 12 and Under

Open to ages 1 - 12.

$0.00

(Group Pricing)

5k Run/Walk - Students

$25.00 + Processing Fee

(Group Pricing)

5k Run/Walk - All Ages

Open to ages 1 - 99.

$30.00 + Processing Fee

(Group Pricing)

10k Run - Children Aged 12 and Under

Open to ages 1 - 12.

$0.00

(Group Pricing)

10k Run - All Ages

Open to ages 1 - 99.

$35.00 + Processing Fee

(Group Pricing)

Would you like to join or create a Group/Team?

Yes No

Waiver

I hereby release Fairfield Medical Center and all race sponsors and officials from all claims of damages that may arise from my participation in the Heart & Lung Run. I have full knowledge of all the risks involved and certify that I am physically fit and have trained sufficiently to participate in this race. By agreeing below, I give my permission to use my name and photograph for release of results and for promotional purposes of the aforementioned event.

By checking this box, I agree to the waiver and that I am 18 or older, or that I have the authority to register these participants and agree to the waiver for them, and agree to the Privacy Policy.

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Heart and Lung Run

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Registrant #1

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Choose Your Event *

Would you like to join or create a Group/Team?

Waiver

5k Social Teams Pricing

10k - Social Teams Pricing

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Registrant #1

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Choose Your Event *

Would you like to join or create a Group/Team?

Waiver

5k Social Teams Pricing

10k - Social Teams Pricing

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