First Name

Last Name

Email Address

Phone Number

Will you be buying a T-Shirt? Will you be buying a T-Shirt? Yes No

Please select T-Shirt Size Please select T-Shirt Size S M L XL Other

Will you be purchasing Lunch? Will you be purchasing Lunch? Yes No

Lunch Options Lunch Options Ham Turkey Veggie

What is your competitive level? What is your competitive level? Elite - I'm racing for time Average - I want to enjoy the run and the day Family - I'm here with my kids & grandparents

By checking the box below, Participant acknowledges, agrees, and consents to all of the following: (A) Physical exercise and training can be a hazardous activity and, despite taking reasonable precautions, there are inherent risks, including but not limited to serious injury, permanent disability, disease (e.g., COVID-19), or in rare cases, even death. Furthermore, such risk may be due to not only your own actions, but also the action, inaction or negligence of others, the conditions of the premises, or of any of the equipment used. (B) By participating in physical exercise, you do so entirely at your own risk and you accept sole responsibility for any and all injury or damage to you as well as any and all other illness, damage, loss, claims, liabilities or expenses of any kind that you may suffer in any way arising out of or in connection with this event. (C) You understand that this statement agreed to by you will be used to defend any claim you may try to bring against Appalachian Regional Healthcare System, Inc. or any of its employees, affiliates, or agents. By checking the box below, Participant acknowledges, agrees, and consents to all of the following: (A) Physical exercise and training can be a hazardous activity and, despite taking reasonable precautions, there are inherent risks, including but not limited to serious injury, permanent disability, disease (e.g., COVID-19), or in rare cases, even death. Furthermore, such risk may be due to not only your own actions, but also the action, inaction or negligence of others, the conditions of the premises, or of any of the equipment used. (B) By participating in physical exercise, you do so entirely at your own risk and you accept sole responsibility for any and all injury or damage to you as well as any and all other illness, damage, loss, claims, liabilities or expenses of any kind that you may suffer in any way arising out of or in connection with this event. (C) You understand that this statement agreed to by you will be used to defend any claim you may try to bring against Appalachian Regional Healthcare System, Inc. or any of its employees, affiliates, or agents. I Agree