Your Name (Must be 18 or older): 

Your Age Sex

Phone Number Where You Can Be Reached During the Day: 

Your Mailing Address:
     Address: 
     City: 
     Zip: 

Your Email Address: 

Names of Children 6 or younger who will be running with you:

     

Names of Children ages 7 - 15 participating: (registration fee is age in dollars)
     
        Age    Sex 

     
        Age    Sex 

     
        Age    Sex 

     
        Age    Sex 

     
        Age    Sex 

Names of Children ages 16 - 17 participating: (registration fee $20)
     
        Age    Sex 

     
        Age    Sex 

For the people registered above, we will need the following Tee Shirts:
   Adult Size Small - We need shirts
   Adult Size Medium - We need shirts
   Adult Size Large - We need shirts
   Adult Size Extra Large - We need shirts
   Adult Size Double Extra Large - We need shirts
   Child Size Large - We need shirts
These shirts may be picked up at the event between 8 AM and 9:30 AM, or after the run. They will be sorted by the adult's name on this form.
   

*Enter Your Credit Card Number  & *ExpDate 

*Enter The Name That Is On The Credit Card 

My number one resolution for 2009 is:

Please read the Waiver below. If you accept these conditions, please click on the submit button below to send in your registrations and payment. Clicking on the submit button indicates acceptance of this waiver.

Liability waiver: Upon completion of my entry, I, for myself, my heirs & assigns, hereby release and hold harmless Trident United Way, RMS Sports, the City of Charleston and any and all sponsors, volunteers & officials of this event from any and all liability rising from illness, injury or death I may suffer as a result of participation in this event. I attest I am physically fit and have sufficiently trained for this event and am aware my participation could, in some circumstances, result in physical injury. Should officials determine completion of this event would be injurious to my health, I consent to be removed from the event. I give permission for free use of my name and picture in any broadcast, telecast or written account of this event. I also understand that the entry fee is NON-REFUNDABLE FOR ANY REASON.

If you have any questions, please contact Tammy Thompson
at tthompson@tuw.org or 843-740-9000 Ext. 245