EmailMe Form - Sponsoring Survivorship 27th Annual Run/Walk 2023

Sponsoring Survivorship 27th Annual Run/Walk 2023

Saturday, October 7 2023

Silveira Community Center
500 North Main Street, Downtown Lakeport CA

Mail in or Online Registration by 9-25-2023
Morning Registration 7:00 AM TO 8:30 AM
Event Starts at 9:00 AM RAIN OR SHINE

Bring the family to Sponsoring Survivorship’s 27th Annual Run/Walk. There will be refreshments and
raffle prizes. All participants will receive a free T-Shirt.

Everyone is a Winner!
Special thanks to our Business Sponsors and our Local Community.

Please be aware of Local Covid-19 restrictions.
Registration Fee: $25.00

Proceeds benefit Lake County individuals who have been diagnosed with breast cancer.

Brandi Cubbage 432-614-7707 Julie Kelley 707-972-0286

Email: sponsoringsurvivorshiplc @gmail.com
Website: sponsoringsurviviorship.com
Facebook: fb.com/ sponsoringsurvivorship
Instagram: @sponsoringsurvivorship

Name *
First Middle Last
Mailing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Email *
Phone *
### - ### - ####
I am a ... *
Male
Female
Is this your first time to participate in the Run/Walk? *
Yes
No
I will participate in:
2K Walk
5K Walk
5K Run
10K Run
Registration Fee
$ Dollars
Donation
$ Dollars . Cents
Non Profit #45-3321877
WAIVER
I know that running a road race is potentially a hazardous activity. I should not enter a run/walk unless I am healthy and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete a race. I assume all risks associated with running/walking this event including, but not limited to: falls, contact with other participants, the effects of the weather, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver, knowing all these facts and in consideration fo your accepting my entry, I for myself, heirs, and anyone entitled to act on my behalf, waive and release forever Sponsoring Survivorship, City of Lakeport, County of Lake and all sponsors, their employees, representatives and successors from all claims and liabilities.
SIGNATURE * *
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Please sign with your mouse or input tool. (Don't worry, it's ok if it is messy)

After you submit the form, you will be directed to the Paypal interface where you can pay by credit card or Paypal.