2013 Villa Maria-thon Pre-registration
                                                                        5-K Run & 2-mile Walk  ~~  Saturday, June 1, 2013, 9:00 AM
                                                                                                *Registration opens at 7:30 AM
                                                                                                     *Event held rain or shine
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First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
Phone *
Alternate Phone
E-Mail Address
Please provide for registration confirmation
Male or Female *
Please select one
Age Group *
Please select one
Pre-registering for *
Please select one
Please select T-shirt size *
(T-shirts are not guaranteed for post-May 15 registrations)
Payment information
Pre-registered participants may send a check by U.S. Mail to VMESC – Villa Maria-thon, 2067 Evergreen Road, P.O. Box 424, Villa Maria,  PA  16155 (please indicate "pre-registered" in the memo of your check).   Payment will also be accepted at event registration tables beginning at 7:30 on the day of the event.  For your added convenience, we also accept payment in advance using your MasterCard, Discover or Visa credit card by telephone at 724-964-8886.  (You may click mark below if you prefer a member of our staff to contact you at the telephone number listed above.)  Payment must be received prior to start of event to permit participation.  
Please read then click mark *
In consideration of the acceptance of my entry, I, for myself, my executors, administrators, and assignees, do release, discharge, and hold harmless Villa Maria Education & Spirituality Center and its officers, directors, volunteers, staff, and sponsors, from any and all claims, damages, demands, or causes of action whatsoever in any manner directly or indirectly arising out of or related to my participation in said athletic event; I am physically fit and have sufficiently trained to participate in this event. By signing below I give permission without compensation to use my likeness in photographs and/or videos for purposes of promoting Villa Maria Education & Spirituality Center. I agree to abide by all the rules of participation and acknowledge that the race committee may refuse or return any entry at its discretion.
Required
Thank you for your interest in our programs!
*Should you encounter problems with this registration form, please contact us at 724-964-8886 or dstiger@humilityofmary.org
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