Capitol City Hot Chocolate 5K – Jefferson City Roadrunners

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info@runjeffcity.org

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PO Box 121
Jefferson City, MO 65102

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Capital City Hot Chocolate 5K

Signature
Name*
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Please list the best contact number for you.
Are you a member of the Jefferson City Roadrunners Club?*
- Yes
- No
Shirt Size*
- Youth
- Unisex Small
- Unisex Medium
- Unisex Large
- Unisex X-Large
- Unisex XX-Large
Please select the best size shirt for you - these are unisex shirts. Shirts guaranteed to the first 100 Entrants
Age*
Please submit your age on December 16, 2023.
Gender*
- Female
- Male
Race*
- 5K Run - Some walking allowed
- 5K Walk - NO JOGGING allowed
Note: There is a $2 processing fee per race entry.
Race Entry Fee for entry #1*
Price:
Signature*
NOTE: IF YOU ARE UNDER 18 years of age this form must be signed by your legal guardian. RELEASE: In the consideration of the acceptance of my entry, I, for myself, my administrators, executors and assignees, do hereby release, and discharge the Jefferson City Roadrunners and all other sponsors for all claims of damages, demands and actions, whatsoever arising or growing out of my participation in said athletic event. I attest and verify that I have full knowledge of the risk involved in this event and I am physically fit and trained for this event
Would you like to register more than one person for the race?*
- No
- Yes
Second Entry
Name*
First Last
Are you a member of the Jefferson City Roadrunners Club?*
- Yes
- No
Is the contact information the same for both entries?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Please list the best contact number for you.
Shirt Size*
- Youth
- Unisex Small
- Unisex Medium
- Unisex Large
- Unisex X-Large
- Unisex XX-Large
Please select the best size shirt for you - these are unisex shirts. Shirts guaranteed to the first 100 Entrants
Age*
Please submit your age on December 16, 2023.
Gender*
- Female
- Male
Race*
- 5K Run - Some walking allowed
- 5K Walk - NO JOGGING allowed
Note: There is a $2 processing fee per race entry.
Race Entry Fee for entry #2*
Price:
Signature*
NOTE: IF YOU ARE UNDER 18 years of age this form must be signed by your legal guardian. RELEASE: In the consideration of the acceptance of my entry, I, for myself, my administrators, executors and assignees, do hereby release, and discharge the Jefferson City Roadrunners and all other sponsors for all claims of damages, demands and actions, whatsoever arising or growing out of my participation in said athletic event. I attest and verify that I have full knowledge of the risk involved in this event and I am physically fit and trained for this event
Would you like to register more than two people for the race?*
- No
- Yes
Third Entry
Name*
First Last
Are you a member of the Jefferson City Roadrunners Club?*
- Yes
- No
Is the contact information the same for all three entries?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Please list the best contact number for you.
Shirt Size*
- Youth
- Unisex Small
- Unisex Medium
- Unisex Large
- Unisex X-Large
- Unisex XX-Large
Please select the best size shirt for you - these are unisex shirts. Shirts guaranteed to the first 100 Entrants
Age*
Please submit your age on December 16, 2023.
Gender*
- Female
- Male
Race*
- 5K Run - Some walking allowed
- 5K Walk - NO JOGGING allowed
Note: There is a $2 processing fee per race entry.
Race Entry Fee for entry #3*
Price:
Signature*
NOTE: IF YOU ARE UNDER 18 years of age this form must be signed by your legal guardian. RELEASE: In the consideration of the acceptance of my entry, I, for myself, my administrators, executors and assignees, do hereby release, and discharge the Jefferson City Roadrunners and all other sponsors for all claims of damages, demands and actions, whatsoever arising or growing out of my participation in said athletic event. I attest and verify that I have full knowledge of the risk involved in this event and I am physically fit and trained for this event
Would you like to register more than three people for the race?*
- No
- Yes
Fourth Entry
Name*
First Last
Are you a member of the Jefferson City Roadrunners Club?*
- Yes
- No
Is the contact information the same for all four entries?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Please list the best contact number for you.
Shirt Size*
- Youth
- Unisex Small
- Unisex Medium
- Unisex Large
- Unisex X-Large
- Unisex XX-Large
Please select the best size shirt for you - these are unisex shirts. Shirts guaranteed to the first 100 Entrants
Age*
Please submit your age on December 16, 2023.
Gender*
- Female
- Male
Race*
- 5K Run - Some walking allowed
- 5K Walk - NO JOGGING allowed
Note: There is a $2 processing fee per race entry.
Race Entry Fee for entry #4*
Price:
Signature*
NOTE: IF YOU ARE UNDER 18 years of age this form must be signed by your legal guardian. RELEASE: In the consideration of the acceptance of my entry, I, for myself, my administrators, executors and assignees, do hereby release, and discharge the Jefferson City Roadrunners and all other sponsors for all claims of damages, demands and actions, whatsoever arising or growing out of my participation in said athletic event. I attest and verify that I have full knowledge of the risk involved in this event and I am physically fit and trained for this event
Would you like to register more than four people for the race?*
- No
- Yes
Fifth Entry
Name*
First Last
Are you a member of the Jefferson City Roadrunners Club?*
- Yes
- No
Is the contact information the same for all five entries?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Please list the best contact number for you.
Shirt Size*
- Youth
- Unisex Small
- Unisex Medium
- Unisex Large
- Unisex X-Large
- Unisex XX-Large
Please select the best size shirt for you - these are unisex shirts. Shirts guaranteed to the first 100 Entrants
Age*
Please submit your age on December 16, 2023.
Gender*
- Female
- Male
Race*
- 5K Run - Some walking allowed
- 5K Walk - NO JOGGING allowed
Note: There is a $2 processing fee per race entry.
Race Entry Fee for entry #5*
Price:
Signature*
NOTE: IF YOU ARE UNDER 18 years of age this form must be signed by your legal guardian. RELEASE: In the consideration of the acceptance of my entry, I, for myself, my administrators, executors and assignees, do hereby release, and discharge the Jefferson City Roadrunners and all other sponsors for all claims of damages, demands and actions, whatsoever arising or growing out of my participation in said athletic event. I attest and verify that I have full knowledge of the risk involved in this event and I am physically fit and trained for this event
Payment
We use PayPal for secure online payments. Please be patient as you will be redirected to their site. NOTE: You do not have to be a PayPal member to pay. Simply select "Pay With A Debit or Credit Card" at the bottom of the form. Thank you!
Total
$0.00

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(573) 616-9233
info@runjeffcity.org
PO Box 121
Jefferson City, MO 65102

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