First Name

Last Name

Age

Gender:
Male Female

Date of Birth (00/00/0000)

Address

City State Zip

Email

Phone Number

Race Option:
5K Walk

5K Run

10K Run (required for gold cup points)

T-Shirt Size:
Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Waiver of Responsibility*:

(Type in your full name)

*In typing my full name, I assume all responsibility and agree to waive any responsibility for Purdue University North Central, the Calumet Region Striders, and all other sponsors for any injury incurred during said race. I attest that I am physically fit and have sufficiently trained for the 5K/10K Panther Pounce 2009. In addition, if I am under 18 years of age, I certify that I have parent/guardian approval to register.