Certified 5K Run/Walk and 10K Run
 

This year’s Race for Rehab will be held on Sunday, October 12, 2008.
 

 On-line Registration Form

We must receive your payment by Oct. 9, 2008 in order for you to receive the early registration discount. You registration is not complete if we do not receive payment. You will be given instructions for payment once you have submitted your registration information.

 

Download a paper version of this form

Name:
First:    M.I.:
Last:   

 
Mailing Address:
Street: 
City:    

State:  

Zip:     

How did you hear about the Race for Rehab?

Other:
Contact Information:

Daytime phone:

Evening phone:

Email:
Age on day of race:      years old What event are you participating in?: 

 5K    10K
Birth date:     
Gender:

                 Male        Female

Shirt Size:

 

Small    Medium    Large    X-large 

The Race for Rehab is for runners of all abilities and ages.

A day of family fun is guaranteed.

To read the legal disclaimer click here.  Additional information will follow the submission of this form.  Please print the confirmation as a receipt and for future reference.