If you would like to pay by credit card, please submit a completed form for each runner,
then pay through Pay Pal using pay@irbhome.com.

If you will be paying for more than one runner, please list the names of all the people you are registering in the Pay Pal description field

Name
Address
City	State	Zip
Email Address	Phone Number		Age
Shirt Size - Small, Medium, Large, X-Large or Child	Male or Female

By submitting this registration, I acknowledge that participating in this event is potentially hazardous, and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur while I am traveling to or from the event, during the event, or while I am on the premises of the event. I also am aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I, for myself and my heirs and executors, hereby waive, release and forever discharge the event organizers, sponsors, promoters, Active.com and each of their agents, representatives, successors and assigns, and all other persons associated with the event, for my all liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise. I understand that the entry fee is non-refundable and non-transferable. I hereby grant full permission to any and all of the above parties to use any photographs, videotapes, motion pictures, website images, recordings or any other record of this event. Yes

     

Questions? Email us at info@irbhome.com

Please submit a separate form for each person in your party,
then pay through Pay Pal using pay@irbhome.com.

If you will be paying for more than one runner, please list the names of all the people you are registering in the Pay Pal description field