GulfCoastGiving's first annual Upgrade 2 Success 5K Run/Walk

5K Run/Walk Event Registration

PLEASE FILL OUT ONE ENTRY FORM FOR EACH PERSON

Read the waiver, sign and mail. Your payment must be included with your entry form. Incomplete, unpaid, or unsigned entries will not be accepted. Shirts can be picked up at designated locations after March 1, 2012. Participants can also pick up their packets at Walsingham Park the day of the event. Shirts guaranteed to the first 500 entries while they last.

Name: *

E-Mail Address: *

Date of Birth: *

Gender:

M F

Address: *

City: *

State: *

ZIP: *

Phone: *

Emergency Contact Name:

Emergency Contact Phone:

Please indicate size and quantity of t-shirts (adult & youth) *

Please indicate which school your child attends: *

How many children under 18 are you registering for free?: *

$20 Early Registration ends March 15th. Regular Registration is $25 March 16th-April 6th. Registration includes 1 adult shirt and 1 youth shirt. Extra youth shirts are available for $5 each. Please enter the amount you wish to pay into PayPal after clicking the submit button

Please contact Jessica Shafer (727) 410-7013 with any questions.
Jessica@GulfCoastGiving.org

Download the Registration Form and email/fax/mail it in to our offices.

By submitting your online registration form you agree to our Waiver and Release conditions.

Waiver and Release
In consideration of the foregoing, I, for myself, my heirs, executors, administrators, personal representatives, successors and assigns, waive and release any and all rights, claims and courses of action I have or may have against Gulf Coast Giving’s Upgrade 2 Success 5k Run/Walk, the city of Largo, Pinellas County, Pinellas County School Board and any and all sponsors, their representatives and successors, that may arise as a result of my participation in Gulf Coast Giving’s Upgrade 2 Success 5k Run/Walk and any pre- and post- event activities. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose including commercial advertising.