Race Registration – In Pursuit PCA

Participant Information

First Name *

Last Name *

Date of Birth *

Gender *

Race Category *

5K Race Runner

Start time: 8:00 AM

$35

5K Race Walker

Start time: 8:00 AM

$35

1 Mile Walk / Fun Run

Follows 5K start

$25

Event T-Shirt Size *

Included with registration

Youth Sizes

Adult Sizes

Additional T-Shirt Add-on($20 each)

Want extra shirts? Select a size for each one.

Quantity

I am a Prostate Cancer Survivor

Contact Information

Primary contact for this registration (confirmation will be sent here).

Email Address *

Phone Number *

Street Address *

City *

State *

ZIP *

Emergency Contact

Full Name *

Phone Number *

How Did You Hear About Us?

Were you referred by a business, organization, or individual? Let us know! (optional)

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Waiver & Release

PARTICIPANT WAIVER AND RELEASE OF LIABILITY

In consideration of being permitted to participate in the In Pursuit PCA Race Event, I, the undersigned, intending to be legally bound, hereby waive, release, and forever discharge In Pursuit Mississippi Prostate Cancer Awareness, its officers, directors, employees, volunteers, agents, and sponsors from any and all claims, demands, losses, or damages arising out of or related to my participation in this event, including but not limited to personal injury, death, or property damage, whether caused by negligence or otherwise.

I acknowledge that participating in a running/walking event involves inherent risks, including but not limited to physical exertion, weather conditions, and contact with other participants. I certify that I am physically fit and have not been advised otherwise by a qualified medical professional.

I grant permission to In Pursuit PCA to use photographs or videos taken of me during the event for promotional purposes without compensation.

I have read this waiver and release, fully understand its terms, and sign it freely and voluntarily. By checking the box below, I also agree on behalf of all participants listed in this registration.

I have read and agree to the Waiver and Release of Liability on behalf of all registered participants. *

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Total Due$0.00

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