breakaway5k.org

Two Ways To Register! Fill out the form below then click
continue. On the next page you will be prompted for payment by mail or
payment online through PayPal for Visa, MasterCard, Discover, AmEx, or eCheck

Use one form per entry. You are not reqired to have a PayPal account to
make Credit Card payments online through Breakaway5K's PayPal system.

Last Name:
First Name:	MI:
Email Address:
Age on Race Day:
	Male Female

Address Line 1:
Address Line 2:
City:
State:
Zip:

Age Group:
Select Race:	Fun Run $10 5k Race $17
Tshirt Size:	Small Medium Large Xtra-Large

Where did you hear about the race?

No Refunds, exchanges or transfers. I know that running a road race is a potenitally hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running this event including, but not limited to, falls, contact with other participants, the effects of the weather including heat and/or humidity, traffic and the conditions of the road; all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release the Town of Old Orchard Beach, Maine Track Club and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. BY ENTERING MY INITIALS AND CLICKING THE "SUBMIT" BUTTON BELOW, I ALSO ACKNOWLEDGE THAT I HAVE READ THIS NOTICE AND HAVE CONSENTED TO ITS CONDITIONS. INITIAL HERE: