The 29th Annual Sacred Mountain Prayer Run Saturday, June 2, 2012
Photograph: John Running
Registration Form Register By:
April 30
May 1st—June 1st
Race Day
Total
10k
$ 40.00
$ 45.00
$ 50.00
$
5k
$ 30.00
$ 35.00
$ 40.00
$
NOTE: All fees include a long sleeve t-shirt with an original artist design. Request T-shirt size: Children:
Lg
Adult:
Sm
Md
Lg
XL
XXL
Free 2k Fun Run/Walk - On site registration only. Contact Brenda Gene at
[email protected] TOTAL AMOUNT DUE $
First Name
Last Name
Age
Date of Birth
Gender:
Male
Female
Street/P.O Address City Phone (
State )
-
Zip
Email Ok to Contact?
Yes
No
I, intending to be legally bound hereby for myself and heirs, executors and administration, waive and release any and all rights, claims or damages I may accrue against Native Americans for Community Action, Inc., City of Flagstaff, any and all race sponsors, their representatives, successors and assignees for any and all injuries suffered by me at the NACA Sacred Mountain 10k/5k Prayer Run and Fun Run/Walk. I also attest that I am in good physical condition and able to compete in my chosen race and here by give consent to use any photographs for publicity/promotional use. Proceeds to benefit NACA programs and clients with emergency need. Sorry, NO REFUNDS. No personal checks.
Signature:
(Parent/Guardian if under 18 years of age)
NACA Main Office: 2717 N. Steves Blvd. Ste. 11 Flagstaff, AZ 86004 Phone: 928-526-2968 More information please contact: Dorothy Gishie ext. 126,
[email protected] Rose Toehe ext. 122,
[email protected]
