Abolish Breast Cancer 5K Run and Walk

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Abolish Breast Cancer 5K Race/Walk (ABC 5K)
All proceeds go to the Dana-Farber Cancer Institute for Breast Cancer Research

This event is officially endorsed by Dana-Farber Cancer Institute.

Abolish Breast Cancer 5K Run/Walk Registration Form

Register using this online form or print a form to fill out by hand.

All proceeds will go to Dana-Farber Cancer Institute for Breast Cancer Research

FEES:

Pre-Registration (by September 16) - $15*
Registration after 9/16 - $20*
Youth Registration - $10*

Fee FREE: Participants with a min. of $75 in pledges will have registration fee waived. (Pledges must be turned in prior to the start of the race/walk. Download your pledge sheet here!

* Registration fee is not tax deductible.

Awards for Top 3 in each Division.

ABC 5K REGISTRATION FORM

EmailMeForm

I plan to: *

Walk

Run
First Name: *
Last Name: *
Sex: *

Male

Female
Adult Male & Female Divisions (select age)

18 - 29

30 - 39

40 - 49

50 - 59

60 - 69

70+
Youth Divisions (select age)

12 and under

13 - 17
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number (We will only use this in case we need to contact you with event changes. A cell number may be preferable as it will enable you to reach you in the event of last-minute changes.) *
### - ### - ####
Emergency Contact (name) *
Emergency Contact Phone *
### - ### - ####
Email - Please provide your email address if you would like us to alert you about next year's ABC 5K event!
T-shirt size (if you pre-register by 9/16, you will receive a t-shirt):

Adult - S

Adult - M

Adult - L

Adult - XL

Adult - XXL

Youth - M

Youth - L
RELEASE

Please read and type your name in the field below to acknowledge your understanding and acceptance of this release.

(Parent or Guardian must sign if participant is under 18 years of age.)

I recognize that road racing is a potentially hazardous activity. In exchange for acceptance of this entry, I for myself, my executors, my administrators and assigns, do hereby release any rights and claims for damages that I may have against the Dana-Farber Cancer Institute, Town of Pomfret, race organizers, and any and all sponsors and individuals involved in the presentation and conduct of the ABC 5K Race/Walk. I understand participation in this event involves rigorous physical activity and risks of physical injury, and I assume these risks. I hereby consent to emergency transporation and treatment in the event of illness or injury. I hereby accept responsibility for the payment of any emergency transportation or treatment. I further certify that I am in good physical condition, and I have no medical or physical conditions that would restrict my participation in the event.

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