Register for the Road Race

Runner's Information

Name*

First Last

City*

State*

Gender*

Female
Male

Age on July 4

Email*

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Registration Type*

Please select the division you are in, based on your age.

Special Awards

Check any that apply to this runner.

1st Cumberland Resident
1st Firefighter
1st Police Officer
Bryan Sweeney Award (1st CHS boy)

Club or School

U.S.A. TRACK & FIELD REG. #

T-Shirt

PLEASE ENTER ME IN THE ARNOLD MILLS PARADE ASSOCIATION’S 4 MILE ROAD RACE. IN CONSIDERATION OF THIS ENTRY BEING ACCEPTED, I HEREBY FOR MYSELF, MY HEIRS EXECUTORS AND ADMISTRATORS WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ARNOLD MILLS PARADE ASSOCIATION, U.S.A. TRACK & FIELD, THE TOWN OF CUMBERLAND, REPRESENTATIVES, SUCCESSORS, AND ASSIGNS FOR ANY AND ALL INJURIES, DAMAGES EXPENSES OR LOSSES WHATSOEVER RESULTING FROM MY PARTICIPATION IN SAID RACE.

BY U.S.A. TRACK & FIELD RULES, RUNNERS PUSHING STROLLERS AND BICYCLES PACING RUNNERS ARE PROHIBITED FROM THE COMPETITION. PLEASE, IF YOU MUST, START IN THE REAR OF THE PACK AND DO NOT GO THROUGH THE CHUTE, SAFETY IS UTMOST IN OUR MINDS.

Name of Parent*

(if runner is under the age of 18)

Waiver*

I agree to the above waiver

Payment

Total amount to be paid via credit card

$ 0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

This field is for validation purposes and should be left unchanged.