5K Registration Form

Cheshire Home Expands On-site Physical and Occupational Therapy Center!

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5K Registration

5K Registration Form

How to Register: Fill out and submit the 5K Registration Form below, then complete your registration on the next screen where you can make an online secure credit card payment. We accept Visa, Mastercard, Discover and American Express.

Sunday, September 20, 2015

$10 Runners Under 14
$20 USATF Members Pre-registered by September 14th
$23 Non-members Pre-registered by September 14th
$30 Registration after September 14th

Walkers are welcome!
Trophies awarded in 15 different age groups!
10% group discounts for 8 or More! 5% for 4-7!

Entry Form

First Name: *

First Name is required.Minimum number of characters not met.

Last Name: *

Last Name is required.Minimum number of characters not met.

Address: *

Street Address is required.Minimum number of characters not met.

City: *

City is required.Minimum number of characters not met.

State/Province: *

Zip Code: *

Zip Code is required.Minimum number of characters not met.

Country: *

Phone - Daytime: *

A Daytime Phone Number is required.Minimum number of characters not met.

Phone - Evening: *

An Evening Phone Number is required.Minimum number of characters not met.

Email Address: *

An Email address is required.Invalid Email Format.

Age: *

Your Age is required.Minimum number of characters not met.

Date of Birth: *

A Birth Date is required.Minimum number of characters not met.

Gender: *

Male Female Please make a selection.

USATF - NJ #:

Additional Runners

If registering additional runners, please enter the following information in the Box below: Name, Age, Date of Birth, Gender, USATF - NJ # if member, email address optional.

Submission of this form indicates that you expressly release and discharge Cheshire Home, USATF New Jersey and any and all sponsors, organizers, directors, volunteers or employees from any and all claims, demands and actions or judgements of any kind arising out of participation in this event. Further, I hereby grant permission to any and all of the foregoing to use any photographs, videotapes or any other record of this event for any legitimate purpose.

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