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Team Area
Sunday, November 3, 2013 (06:30 AM - 11:00 AM)

* Required fields

* First Name:
* Last Name:
* Address:
* City:
* State:
or * Province:
* Zip/Postal Code:
* Country:
* Gender	Female Male
* Date of Birth:
* Email :
* Home Phone:
Work Phone:
*T-shirt Size:
Group Name (if applicable):
*I'm available to volunteer in the Komen office during the week.:
Comment (eg: who you'd like to work with, or, list second volunteer choice):

PLEASE READ AND AGREE TO WAIVER
RACE RELEASE (MUST BE SIGNED BY PARTICIPANT OR APPLICATION WILL BE REJECTED): I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I know that this event is a potentially hazardous activity and I herby assume full and complete responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event, and I hereby release and hold harmless and covenant not to file suit against The Susan G. Komen Breast Cancer Foundation, Inc., its local Affiliates and any affiliated individuals, the Komen San Diego Race for the Cure, and any affiliated individuals, any Race sponsors and their agents and employees, and all other persons or entities associated with this event (the Releasees) from any loss, liability, damage, or claims I may have arising out of my participation in this event, including personal injury or damage suffered by me or others, whether same be caused by falls, contact with other participants, conditions on the course, negligence of the Releasees or otherwise. If I do not follow all the rules of this event, I understand that I may be removed from the competition. I give my full permission to the Komen Foundation and its local Affiliates and Races and their sponsors and corporate partners to use any photographs, videotapes, or other recordings of me that are made during the course of this event. For the safety of all participants, our insurance company requests that in-line skates and pets not be allowed at the event. This event will occur rain or shine. We reserve the right to cancel in extreme circumstances. Cancellation will occur only due to extreme circumstances

INFO FOR PARENT/GUARDIAN COMPLETING THIS REGISTRATION
Registration for minors must be completed by a Parent or Legal Guardian. If your age on race day is less than 18 years old, please fill in the Parent/Guardian Contact Information below. Providing such information and continuing this process indicates that this registration was completed by the person listed below.
Parent/Guardian Name:
Contact Phone:
Contact Relationship:

*Agree to waiver:	I agree I do not agree