RACE REGISTRATION FORM

Registration and Packet Pick-Up

Wild Pear Running, 9330 Broadway, Ste. 400 Tues, Wed and Thurs, May 3, 4 and 5

11:00 a.m. – 8:00 p.m.

Race Day Registration

Pearland Town Center Pavilion 6:00 a.m. – 6:45 a.m.

DATE: Saturday, May 7, 2016 LOCATION: Pearland Town Center, 11200 Broadway, Pearland TIMES: 7:00 a.m. (10K) 7:20 a.m. (5K)

Entry Fees: ☐Male ☐Female

DOB: _______ Age on Race Day: ____

Fees Paid (Circle One): Early 3/1-5/5 Race Day 10K/5K Run: $30 $35 $40 5K Walk: $25 $30 $35 Kids’ Fun Run: Child’s Age: ____ (FREE)

Are you a: PARC Member #: ___________________ HARRA Member #: _________________

$5 Discount for PARC and HARRA Members

Adult T-Shirt Size (Guaranteed if registered by 4/3/16):

☐ S ☐ M ☐ L ☐ XL ☐ XXL

Last Name: __________________________ First Name: _________________________

Address: ______________________________________________________________

City: ________________________________ State: _____ ZIP: __________________

Phone: _____________________________ Email:_____________________________

Release of Liability: In consideration of my participation in the PCPAAA Pear Run, I assume full and complete responsibility for any injury or damage done to my person or party that may occur during said participation, or while I am on the premises utilized by said event and I hereby release and hold harmless the sponsors, promoters, the City of Pearland, and all other persons or entities associated with this event from any and all injury, damage or expense suffered by me, whether it be caused by my own negligence or the sponsors or promoters or other entities associated with the event or agents or employees or otherwise. Participant Signature: ___________________________________ Date: ____________ Parent/Guardian Signature: _______________________________ Date: ____________

For CASH or CHECKS, make payable to: PCPAAA, 2555 Cullen Parkway, Pearland, TX 77581 Deadline to register by mail: April 30, 2016; Please register at Packet Pick-Up or on Race Day

FOR OFFICE USE ONLY: Date Received: __________________ ☐ CASH ☐ CHECK # ______ ☐ ONLINE PAYMENT MADE ON (Date): _______________________ NOTES: ______________________________________________________________

If you paid online at PearRun.com: Date Paid: __________________________

Pearland Citizens Police Academy Alumni Association 2016 PEAR RUN 10K RUN /5K RUN/WALK