EmailMeForm
SATURDAY, OCTOBER 8, 2016
Registration 7:30 to 8:30 a.m.
Race Starts at 9:00 a.m.
CLICK LOGO ABOVE TO VIEW or PRINT POSTER
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
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Barbados
Belize
Canada
Cayman Islands
Cook Islands
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Nicaragua
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Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
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Bolivia
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Austria
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Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
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Laos
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Russia
Saudi Arabia
Singapore
Sri Lanka
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Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
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Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Email
(Note: Used for this event only - it won't be shared)
Registration Fee:
$20 (includes bib, t-shirt and light refreshments) T-shirts guaranteed to those who register by September 11th.
Your registration will be received at MSBC. Please make checks payable to Strong Tower Orphanage and mail to PO Box 485, Houlton, ME 04730. Please mark Love Run on memo line.
T-shirt Size:
S
M
L
XL
XXL
Style
Child
Adult
Gender
*
Male
Female
Activity
*
Walker
Runner
Age Division
*
15 & Under .
16-29 .
30-39 .
40-49 .
50 & Over .
Awards: 1st, 2nd awarded to male and female in each running division. There will also be an overall women’s award and overall men’s award
Waiver & Release: Must be signed by all Walkers and Runners
In consideration of my acceptance as a participant in the Strong Tower Love Run/Walk event, I hereby for myself, my heirs, and personal representatives, do waive, release, any and all rights and claims for damages I may have against Strong Tower or any group or person involved with the Strong Tower Love Run/Walk 5K for any and all claims and liability. I certify that I am properly trained for this event and that I am in good health.
Signature of participant:
*
Date
*
MM
/
DD
/
YYYY
Signature of parent if participant is under 18:
Date
MM
/
DD
/
YYYY
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