Run With A Mission 5K - 2021 (Household Registration; 3-5 people)
Please fill out this form and click submit.
Name
*
Name and age - person 2
*
Name and age - person 3
*
Name and age - person 4
Name and age - person 5
Email
*
This address will receive a confirmation email
Phone
*
Address
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Payment
$75.00
T-Shirt Size
*
Please select all that apply.
Adult XL
Adult Large
Adult Medium
Adult Small
Child Large
Child Medium
Child Small
T-Shirt Size
*
Please select one option.
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child S
Select Option
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child S
T-Shirt Size
*
Please select one option.
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child Small
Select Option
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child Small
T-Shirt Size
Please select one option.
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child S
Select Option
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child S
T-Shirt Size
Please select one option.
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child S
Select Option
Adult XL
Adult L
Adult M
Adult S
Child L
Child M
Child S
I acknowledge that my participation in the Run with a Mission 5K Fun Run and Walk involves a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of the other participants of my household, as well as our heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge Alleluia! Lutheran Church, it's staff, officers, volunteers and members from any and all liability for injury, death, or damages and/or any other claims, demands, losses or damages, incurred by me in connection with any aspect of the 5k run and walk.
*
Please select all that apply.
I agree
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Please fill out this form and click submit.
×
Please Fix the Following