SMTWTFS
            1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30            

Harris Jacobs Dream Run/Walk
May 7, 2017

Participant Information

Name :
Address :
City, State Zip :
Primary Phone Number # : (555-555-5555)
Email :
Age as of May 7, 2017 :
Birthday :
Gender :
Team Name (if applicable ):

Packet Pickup Dates (at the MJCCA)


Thursday, May 4 from 5:00 – 9:00 pm
Friday, May 5 from 9:00 am – 1:00 pm

High-Performance T-shirt Size

Please select carefully: you will only be able to exchange your t-shirt for another size after the race if there are sizes available.

Waiver

 I HAVE READ THE MARCUS JEWISH COMMUNITY CENTER OF ATLANTA RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE, CONTINUING AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT OF THE LAW.

Payment Information


Adult:
$30
Child under 12: $15
Phantom Runner: $30 (I’d like to support the race, but won’t be running – just give me the t-shirt!)

This information is transmitted over a secure connection.

Amount to charge :
Card Type :
Name on Card :
Number :
Expiration :

clientuploads/200-width/logo-AffiliateJFGA.jpg