Head for the Cure 2010 Entry Form

You can register in advance either with our online registration system (closed as of May 11th) or by printing and mailing us a registration form.

For online registration: Online registration is closed. Race day registration opens at 7:30am

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

You can download the Sponsorship Form (PDF) Download.

May 15, 2010 :: Registration 7:30am, Event Starts 9:00am.

Location: West Park, Carmel, IN

For more information, contact Michael Sapper Natalie Sapper (click on name for e-mail).

***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. Children 18 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 all pre-May 5th registered entrants (availability and size are not guaranteed after pre-registration - 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): S   M    L   XL

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

Age as of May 15, 2010: _________________(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 _____________