NCC Brave Run 5K Road Race Individual
  1. Name (First, Last)(*)
    Please let us know your name.
  2. DOB (00/00/0000) Age on Race Day(*)
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  3. Male/Female(*)
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  4. I acknowledge that I am over 18 years of age.(*)
    The 5k Brave online registration is restricted to registrants over 18 years of age.Under 18 register by filling out a form that requires both registrant and parent’s signature which can be mailed, faxed or scanned and emailed.
  5. Phone(*)
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  6. Your Email(*)
    Please let us know your email address.
  7. Address(*)
    Please let us know your message.
  8. Waiver Agreement(*)
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    I hereby for myself, my heirs, executors and administrator, waive and release any and all rights and claims for damages I may have against the sponsors, coordinating groups and any individuals associated with the Brave Run 5K 2014, their representatives, successors and assigns, and will hold them harmless from any and all injuries suffered in connection with this event. I attest that I am physically fit to compete in this event. Further, I hereby grant full permission to any and all of the foregoing to use my likeness in all media including photographs, recordings or any other record of this event for any legitimate purpose.