Registration

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Roots of Hope
Registration

Join Run for Roots!

Please fill out the registration form below to join Run for Roots. Once you submit, you will receive a confirmation email.
You can also scan and email the form attached to nathalie@raicesdeesperanza.org.

runforrootsregistrationform.pdf
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Registration Form

Name *

First

Last

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

I would like to receive emails from Roots of Hope. *

Yes No

Date of Birth *

Please include year.

Gender *

Male Female

Which races will you run with us? *

2013 Miami Half Marathon MCM 10K in Washington (Oct 2012) Other

Which types of races are you interested in running with us? (Choose all that apply) *

5K / 3 miles 10K Half Marathon (13.6 Miles) Full Marathon (26.2 Miles)

Performance T-Shirt Size *

XS Small Medium Large XL XXL

Employment *

Unemployed Part-time Full-time Self-employed

Employer / Position *

Please note if you are unemployed.

Estimated Finish Time *

Please include Hr and Min time. This is an approximate time. This is required by ING.

Conditions requiring medication *

Required by ING.

Medications *

Required by ING.

Allergies (Food, Medication, etc) *

Required by ING.

Please list any medical concerns *

Emergency Contact *

Please include First and Last Name

Relationship to You *

Emergency Contact Phone Number *

Please confirm before listing.

Training Dedication *

You can dedicate your race run to an individual.

Dedication *

Is this your first Run for Roots race? *

Yes No

Is this your first Roots of Hope event? *

Yes No

Comments *

Submit