Summer Scurry Registration

Race Info
TOTAL
10K Road Race
Entry Fee $25.00 per person $

5K Road Race:
Entry Fee $25.00 per person $

5K Walk:
Entry Fee $25.00 per person $

1 Mile Family Fun Run

Entry Fee $15.00 per person $

Kids Fun Pass

Entry Fee $10.00 per person $

T-Shirt Size: Y S M L XL XXL

Additional T-Shirts:
All Sizes $10.00 # of t-shirts ______ $

I can not participate / Would like to

make an additional donation to the
[ ] $15 [ ] $25 [ ] $50 [ ] $_____ (Other) $
PMP Research Foundation:

Method Payment: Cash Credit Card Check CC # ______________________

If Credit Card: V MC AMXPRESS Exp. Date ______________
Signature:
Grand Total:
x__________________________ $
Personal Information
E-Mail:*
Valid e-mail is required

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:
City, State, Zip Code :*
Gender:
Date of Birth:
Phone:*

***Please complete one form for each participant. See attached Waiver. Please include one signed
waiver for each participant (including children). Registration will not be processed until all waivers are
received. Contact Lisa at lisa@indexc.com with questions. Thank you!