Run With A Mission 5K - 2022 (Individual Registration)
Please fill out this form and click submit.
T-shirts cannot be guaranteed for those registering Sept. 14 or after.
Name
*
Email
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This address will receive a confirmation email
Phone
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Address
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Payment
$25.00
5 yrs or younger child - free
T-Shirt Size
*
Please select all that apply.
Adult XL
Adult Large
Adult Medium
Adult Small
Child Large
Child Medium
Child Small
If the above registrant is a minor, I certify that I am a parent or legal guardian and give my permission for the above registrant to participate in the Run with a Mission 5K and assume all the risks involved.
Please select all that apply.
I agree
Name of parent/guardian if the participant is a minor
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 my 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 one option.
I agree
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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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.
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