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Payment Method:
 
Payment can be sent to:
Center for Celiac Research
c/o ROCK
1821 Spinnaker Way
Wylie, TX 75098
Credit Card
Registration Date:
 (Ex.MM/DD/YYYY)
Last Name:
 
First Name:
 
Middle Initial:
Gender:
 
Age:
 
Address:
 
City:
 
State:
 
 (Please choose state)
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Phone:
 
  (Ex. 999-999-9999)
Email Address:
 

(Ex.
yourname@domain.com
T-shirt Size:
 
Waiver: (Please put check mark below)
I know that by running or walking a road race is a potentially hazardous activity.  I should not enter and run or walk unless I am medically able and properly trained.  I agree to abide by any decision of a race official relative to my ability to safely complete the run or walk.  I assume all risks associated with running or walking this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat, extreme cold, and/or humidity, traffic and conditions of the road, all such risks being known and appreciated by me.  Having read this waiver and knowing these facts and in consideration of you accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release University of Maryland, Lone Star Celiac Support Group, and Raising Our Celiac Kids, and all sponsors, their representative and successors from all claims or liabilities of any kinds arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of the event for a legitimate purpose.
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