Required field(s) are indicated by an *.
* Entry Type
( Please note that each team member must register seperately.)
* Race Participating Please Choose a Race from the List Below 5K Road Race 1 Mile Family Fun Run 5K Race Walk (Honor System) 5K Competitive Wheelchair 5K Team
* First Name
* Last Name
Organization (If applicable)
* Billing Address
* State Select a State Outside United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming
* Email Address
* Name of Runner
* T-Shirt Size Please choose size from list below: Small Medium Large XL 2XL 3XL Special Order
* Date of Birth / / (MM/DD/YYYY)
* Age on Race Day
Weight Class (If applicable)
If ordering special order T-shirt, please provide details:
( Please note that teams are comprized of 3 to 5 runners.)
5K Run Entry Fee Total
* Payment Preference
Send a check
. . . . . ...... Please make checks payable to: .....
Tulsa Area United Way
Pay with a credit card
Please be assured that all information transmitted through this form is protected by 128 bit SSL encryption.
Credit Card Type Please Select from Pull-Down List Below: Visa MasterCard American Express Discover
Credit Card Name
Credit Card Number
. . . . . . . . . . . . (No spaces or dashes please.)
Credit Card Security Code
Three digit number on back of card.
Credit Card Expiration Date
Month 01 02 03 04 05 06 07 08 09 10 11 12 / Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
NOTICE: THIS ENTRY FORM AND RELEASE FORM IS A CONTRACT WITH LEGAL CONSEQUENCES. PLEASE READ IT CAREFULLY.
I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I also know that although police protection will be provided, there will be a possibility of traffic on the route. I assume the risk of running in traffic. I also assume any and all other risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, and the conditions of the roads, all such risks being known and appreciated by me. Furthermore, I agree to yield to all emergency vehicles. I also am fully aware that baby strollers, baby joggers, pushed wheelchairs and wheels of any kind (except competitive wheelchairs in a separate race), animals and headphones are strictly prohibited and I agree not to have them on the course. Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and waive and release and discharge USATF/Oklahoma/LDR, Tulsa Police Department, Tulsa Auxiliary Police, Glenís Road Race Service, race officials, volunteers and any and all sponsors including, but not limited to the Tulsa Area United Way including any and all of their agents, employees, assigns or anyone acting for or on their behalf from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of, my participating in this event. This release and wavier extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known and unknown. This further grants full permission to sponsors and/or agents authorized by them to use any photographs, videotapes, motion pictures, recordings or any other record of this event for any purpose. Applications for minors will be accepted only with a parent or guardianís signature.
* Waiver Acknowledgement
I have read the run waiver and I accept the terms.
* . . .
(For Administrative use only.)