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Warren Rives Heart Strides 5k

The Fun Run starts at 8 a.m.; 5K starts at 8:30 a.m.

Name:

Address:

City:

State:

Zip:

Email:

Phone:

Age on Race Day:

Date of Birth:

mm/dd/yy

Sex:

Employee:

Event:

5K T-shirt sizes:

Fun Run T-shirt youth sizes:

Payment Type :

If paying by check, please print this application and send with check to:

HPRHS Development
P.O. Box HP-5
High Point, NC 27261

Credit Card Information:

Card Type:

Card Number:

- - -

Card Exp:

Name on Card:

Special Instructions:

Waiver:

I, being in proper physical condition to participate in this event, waive any and all claims against High Point Regional Health System and Rives Race Sponsors and Contributors for illness or injury resulting from my participation in the race.

I am at least 18 years old.

I agree to the waiver.

My Initials