Head for the Cure 2012 Entry Form

You can register in advance either with our online registration system
or by printing and mailing us a registration form.

For online registration: Online registration will open soon.

To download and print the Entry Form (PDF) Download .

You can download the Sponsorship Form (PDF) Download

June 9, 2012 :: Registration 7:30am, Event Starts 9:00am.

Location: West Park, Carmel, IN

For more information, contact Michael Sapper Natalie Sapper

***Please print this page, fill out the form below, and mail completed entry form with a check or money order payable to: Head for the Cure/ABTA. 5K Entry Fee is $20 per person, $23 Timed (race day $25), Students age 10 - 18 $5 and no shirt, Children 9 and under are free but will not receive a T-shirt. All proceeds (100%) from this event will benefit the American Brain Tumor Association (abta.org).

A T-shirt to entrants registered on May 25 or before (availability and size are not guaranteed after May 25th- but we'll do our best to get you the correct size shirt!).

Mail completed application to:

Head for the Cure, Tuxedo Brothers; 6265 Boone Ridge, Zionsville, IN 46077.

Name _________________________________________________________

Street _________________________________________________________

City ___________________________ State _____ Zip ______________

Phone ____________________________

T-Shirt Size (circle one): XS   S   M    L   XL

Please circle one event: 5K Fun Run/Walk or Competitive Run/Walk or Student

Age (optional) as of June 9, 2012: _________________( possible age group awards)

In consideration of the acceptance of my entry, I for myself, my executors and assignees, do release and discharge the Organizers of the event, its volunteers and any other sponsors from all claims of damages, actions and causes of action, whatsoever, in any manner arising or growing out of my participation in said athletic event. I hereby attest that I am physically fit and able to participate in the Head for the Cure 5K run/walk

Signature_______________________________________ Date _____________

Parent's Signature (if under 18)_____________________ Date _____________