Green 6.2 - Saturday, April 28, 2012

When & Where:

CITYCENTRE (www.citycentrehouston.com)
800 West Sam Houston Parkway N
Houston, Texas 77024

8:30 a.m. – 5K start
8:45 a.m. – 10K start
10:45 a.m. – Kids 1K Fun Run

Packet Pickup Information to be posted soon.

Register Below!

Our Sponsors:

Participant information

	First Name:	*
	Last Name:	*
	Address:	*
	City:	*
	Prov/State:
	Postal Code/Zip:	*
	Telephone:	*
	Email Address:	*
	Confirm Email Address:	*
	Date of Birth:
	Gender:	Male Female

	Emergency Contact Name:	*
	Emergency Contact Phone:	*

	How did you hear about us?

Registration type

Green 6.2 10K ($30.00 before 1/1/2012)
Green 5K ($30.00 before 1/1/2012)
Kid's K Only (Enter child information below)

Kid's K Registration

Include?	Child Name	Age	T-Shirt Size

Coupon Code


	If you have a coupon code, enter it here.

T-Shirt Size

Small (S)
Medium (M)
Large (L)
X-Large (XL)
XX-Large (XXL) ($2.00)
XXX-Large (XXXL) ($2.00)

Payment Information

Credit Card - Mastercard

Credit Card - Visa

Credit Card - American Express

Credit Card - Discover

Subtotal:	$40.00
Oversized T-Shirt Fee:	$0.00
Registration Fee:	$2.50
Processing Fee:	$1.50
Discount:	$0.00
Total Due:	$44.00

Name On Card:
Card Number:
Expiration Date:
CVC/CVV2:

Waiver

I understand that my participation is strictly voluntary on my part.

I understand and agree that I am solely responsible for any injuries that I may suffer while participating in this activity.

If I am injured while participating, I agree to release and hold harmless from any liability or responsibility the owners, management, staff, and employees of Race Assist, LLC. or City Center.

I agree to these conditions as a prerequisite to participating.