YMCA Half Marathon & 5K

Sponsored by
Peterborough Regional Vascular Health Network

Race Date: Sunday, February 24, 2008

Registration Form

1) Fill in information , 2) Print this page 3) Sign & date at bottom, and 4) Mail registration to:
Attn: Race Registry, YMCA of Peterborough, 123 Aylmer Street S, Peterborough, ON  K9J 3H8

Please ensure the information is completed and accurate. We cannot be responsible for errors made that may affect timing or prizes.

Participant Information:

Last Name: First Name:
Address: Apt#:
City: Province: Postal Code:
Telephone: Sex: Female Male Age:
E-mail Address:
Club Name:

Type of Race:

Registration Costs:

 Half-Marathon 5K 1K
Now to January 13th $40.00 $25.00 $15.00
January 14th to February 12th $45.00 $30.00 $15.00
February 13th to 24th $55.00 $35.00 $20.00

Payment Information

Cheque Enclosed MasterCard Visa
Name on Credit Card:
Card #: Expiry Date:
Cardholder's Signature:

In consideration of your accepting my entry or the entry of my child or ward, I for myself, my heirs, my child or ward, my executors and administrators of those of my child or ward, do hereby release and forever discharge the Corporation of the City of Peterborough, The Peterborough Family YMCA, YMCA Half Marathon Committee and any or all clubs, associations, supporting companies, competitors and persons associated with the competition from and against any loss or damage, occuring prior to, during or subsequent to the event, to my person or property however caused and notwithstanding that the same may have been contributed to or occasioned by the negligence of any of the aforesaid.
By submitting this entry, and checking the box below, I acknowledge having read, understood and agreed to the above release waiver, and indemnity. I warrant that I am physically fit to participate in this event.

Signature Date