Information/Registration Details

Reindeer Romp Registration Form

Name __________________________

Address ________________________

_______________________________

Phone _________________________

5K Run________   1.5mi Walk ______

Age on Race Day ____ Sex: M__ F__

I am interested in sponsorship information __________

I cannot participate, but please accept my donation _________

Method of Payment

___ Check    ____ Mastercard

___ Visa       ____ American Express

_______________________________

Credit Card#

____________

Expiration Date

_______________________________

Name as it appears on Credit Card

• Please make checks payable to the American Cancer Society.

• One form must be submitted for each participant.

• Return signed waiver, completed registration and payment to: American Cancer Society, 1615 West Chester Pike Suite 102, West Chester, PA 19382 Attn: Reindeer Romp by December 2nd or Fax to (610) 692-9738.

Waiver Form

In consideration of my signing this agreement, I hereby for myself, my heirs, and administrators assume any and all risks which might be associated with the Reindeer Romp. I waive and release any and all rights and claims for damages which I may have against the sponsors, organizers, and any others connected with this event, their representatives, successors, and assigns for any and all injuries or damages of any kind suffered by me as a result of taking part in the event and related activities.

Signature _______________________

Must be signed by parent or guardian if under the age of 18.

Cash Awards ($100, $50, $25) to

1st Three Male and Female Overall

Awards to 1st Place Male & Female Age Groups:

19 and under

20-29

30-34

35-39

40-44

45-49

50-54

55-59

60 and over

Special Category - Brandon's Cup 1st Place 14 and under