TWENTY-THIRD Annual Fundraising Event Register for 2023 5 K Race

TWENTY-THIRD Annual Fundraising Event – 2023 5K FUN RUN or WALK

Saturday, October 21, 2023 – Run begins at 9 am, Registration from 7:30 am

Raffle Winners Announcement: Saturday, October 21, 2023, after the run/walk

TWENTY-THIRD Annual Fundraising Event Registration Form

> DOWNLOAD RACE REGISTRATION (PDF)

We will be adding them to a new photo gallery for the 2023 race.

Photos: Please upload your photos of your walk/run to our site. Click here to upload images.

TWENTY-THIRD Annual Fundraising Event – 2023 5K FUN RUN or WALK

Please fill out the below information. Thank you

"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

(Will save paper & postage next year)

Phone*

Type of registration*

$40 - Adult/Teen

$20- Youth 12 and under

(Early registration prices valid until October 10)

Raffle Tickets

Price: $1.00

Raffle Winners will be announced on Saturday, October 21, 2023 at noon.

Age on Race Day*

T-Shirt Size*

(Adult sizing)

T-shirt Pickup/Delivery*

Please mail my shirt and race bib

I will pick up my shirt and race bib (place/times listed below)

Waiver

I, the undersigned as a condition of participating in this event, do hereby for myself, my heirs, executors, and administrators, indemnify and hold harmless the Eastern Sierra Cancer Alliance, and any subsidiaries and related entities, such as its officers, directors, sponsors, employees, lessees, or any agencies or individuals associated with this event for any and all injuries sustained by me in the course of this event. I hereby waive any and all rights of claim for damages I may have against the foregoing, their officers, directors, sponsors, or any agencies or individuals associated with this event for any and all injuries sustained by me in the course of this event. I understand that children age 12 and under registered to participate must be accompanied by a parent or guardian and may not be left unattended by that parent or guardian. If I choose to bring a dog on the walk or run, I will keep the dog on leash and under control at all times and I will be responsible for all of its actions, financially and otherwise. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, verbal or written statements, or any other record of this event for any legitimate purpose without my consent. I am of legal age, have read this release, fully understand it ,and freely agree to all of its terms.

Signature*

Please type your name. EVERY participant must sign! Participants under age 18 must have a parent/guardian signature.

Date of Signature*

Payment

You are AMAZING for adding more!

Total Registration Cost

I wish to pay by*

PayPal

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Please make your check payable to Eastern Sierra Cancer Alliance “ESCA,” include a note about which participant(s) the check covers, and mail by October 10th to:

ESCA
P.O. Box 1523
Bishop, CA 93515

This field is for validation purposes and should be left unchanged.

TWENTY-THIRD Annual Fundraising Event – 2023 5K FUN RUN or WALK

Saturday, October 21, 2023 – Run begins at 9 am, Registration from 7:30 am

Raffle Winners Announcement: Saturday, October 21, 2023, after the run/walk

TWENTY-THIRD Annual Fundraising Event – 2023 5K FUN RUN or WALK

Waiver

Payment

ESCA P.O. Box 1523 Bishop, CA 93515

ESCA
P.O. Box 1523
Bishop, CA 93515