Mail-In Registration Form Fill out this form and mail it with your check payable to: Run For Kathy, 14410 Autumn Crest Road, Boyds, MD 20841. (Or, you could register online.) For more information: info@run4kathy.org or (301) 428-3008.

     Event:5K Run 1-mile Kids Run 1-mile walk (free)
           Name:  
        Address:  
           City:  
          State:  Zip:  
          Phone:  
         E-Mail:  (to confirm registration) 
  Date of Birth:  Age on race date:  
         Gender: M F 


     Shirt Size: 
Youth-Sm Youth-Lg Adult-Sm Adult-Med Adult-Lg Adult-XL 

                T-shirts can only be guaranteed for those 
                 who are pre-registered.  For walkers, if you 
                 would like a t-shirt, please pay the 5k entry fee. 
 How did you hear about us:  
  Did you participate in prior years?:  
      Entry Fee: 5K ($20 until Sept 30; $25 after)
                 Kids Run ($10)
                 Walk (free)
                 Cancer Survivor (free) 
       Donation? (100% to cancer research) 
    TOTAL AMOUNT  Make check payable to Run For Kathy, Inc. 

Waiver Must Be Read and Signed Before Mailing:
I know that running is a potentially hazardous activity. I should not enter or run in club activities unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being know and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the Run For Kathy, Inc., Johns Hopkins Oncology Center, City of Bowie, Prince George's Running Club, plus all other sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

_______________________________  ________ _____________________________________


Signature                          Date   Parent's signature if under 18