Race Registration
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WORLD RUN WEEKEND 2009 1OK, 5K, 1 Mile Fun Run S a t u r d a y, N o v e m b e r 7 , 2 0 0 9 Start Time: 8 AM S o u t h f i e l d Pa r k i n H e b e r C i t y, U T RACE APPLICATION INSTRUCTIONS: 1. Complete Entire Application 2. Download, print and read waiver. Sign below accepting the waiver. 3. Complete Payment Section *Include a check or complete credit card information. 4. MUST BE RECEIVED BY: October 31, 2009 5. EACH RUNNER MUST COMPLETE AN APPLICATION
first name
middle name
mailing address [ ] phone number [
]male
[
MAIL TO: WorldWide Services, LLC PO BOX 394 Heber City, UT 84032
last name city, state, zip
email address [confirmations will be sent via email] ]female
distance you are running
birthdate mm/dd/yyyy [
] 10K
shirt size [all shirts are men’s sizing] please circle S M L XL
[
] 5K
[
] 1 mile fun run
How did you hear about this race? friend flier active.com blogspot
PAYMENT SECTION
[
]I have included a check payable to: WorldWide Services, LLC
credit card type
[
]visa
[
]mastercard
[
other
]discover
credit card number expiration date mm/yyyy [
]$20 for 10K
[
security code on back ]$15 for 5K & 1 mile fun run
[
]$25 after Nov. 5th
PLEASE CHECK THE FOLLOWING IF YOU AGREE :
[
] I am 13 years or older.
[
] I understand there is a no refund policy.
[
] I have downloaded the waiver on www.wasatchraces.blogspot.com and have read it in its entirety and understand and accept the waiver.
[
] In addition to race fees, I understand I am responsible for a $50 NSF fee for returned checks.
signature
[ ] The signed name below is the parent/guardian of the applicant. I have read, understand and accept the waiver.
print name
date
first name
middle name
mailing address [ ] phone number [
]male
[
MAIL TO: WorldWide Services, LLC PO BOX 394 Heber City, UT 84032
last name city, state, zip
email address [confirmations will be sent via email] ]female
distance you are running
birthdate mm/dd/yyyy [
] 10K
shirt size [all shirts are men’s sizing] please circle S M L XL
[
] 5K
[
] 1 mile fun run
How did you hear about this race? friend flier active.com blogspot
PAYMENT SECTION
[
]I have included a check payable to: WorldWide Services, LLC
credit card type
[
]visa
[
]mastercard
[
other
]discover
credit card number expiration date mm/yyyy [
]$20 for 10K
[
security code on back ]$15 for 5K & 1 mile fun run
[
]$25 after Nov. 5th
PLEASE CHECK THE FOLLOWING IF YOU AGREE :
[
] I am 13 years or older.
[
] I understand there is a no refund policy.
[
] I have downloaded the waiver on www.wasatchraces.blogspot.com and have read it in its entirety and understand and accept the waiver.
[
] In addition to race fees, I understand I am responsible for a $50 NSF fee for returned checks.
signature
[ ] The signed name below is the parent/guardian of the applicant. I have read, understand and accept the waiver.
print name
date
