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PRC FUN RUN 2015 REGISTRATION FORM
Name (Last/First/Middle)
Age
Birthday (mm/dd/yyyy)
Mobile #
Gender
Landline #
Male
Female
Email
Address
House # & Street Name
Subdivision
Barangay
Race Distance & Registration Fee (encircle choice)
Race #
Non-Student / Student
7km / P500
4km / P400
2km / P375
Student / P300 (any distance)
Singlet Size (encircle)
(encircle) 2km / 4km / 7km
S / M / L / XL
City
Zip Code
Emergency Contact / Guardian
Name
Phone #
Relationship
Address
Guardian’s Consent for Minors (print name / signature / date)
WAIVER OF LIABILITY
By signing this registration form and participating in the PRC RUN 2015, I agree to abide by the rules of the event and certify that I am fully and physically fit and
adequately trained to finish the race and that I fully accept this Waiver of Liability.
I understand that participating in this event may involve real risk of serious injury or even death from varioius causes, including but not limited to falls, over
exertion, dehydration, contact with other participants, spectators, road users, effect of weather and conditions of the road. I voluntarily assume all risk associated
with my participation in the event or any activity associated with it.
I, in consideration of and as a condition of the acceptance of this registration for myself, my executor, adminstrators, heirs, next of kin hereby waive, release and
forever discharge the event organizers, sponsors, promoters, agents, or servants from all claims, actions or damages that I may have against them howsoever
cause, arising out of or in any way connected with my participation in this event.
I authorize the use of my name, voice and picture in any information provided by myself on this registration form to be used without payment in any broadcast,
telecast, promotion or advertisement. I also agree that the information that I have provided may be used by Philippine Association of the Professional Regulatory
Board Members, Inc. (PAPRB) and by the event organizer for promotions, marketing, sponsorship, and for any other legitimate purpose.
Date
Signature over Printed Name
(PARENT/GUARDIAN IF UNDER 18 YEARS OLD)
Registration Processed by:
Amount Paid:
Official Receipt # / Reference #
Registration Date
Claiming of Singlet & Race Kits from June 1 to 11, 2015 @ PAPRB Office
Name (Last/First/Middle)
Registration Date
Amount Paid
P500 / P400 /P375 / P300
Race #
Singlet Size
S / M / L / XL
Official Receipt # / Reference #
Singlet & Race Kit Released by:
CLAIM STUB FOR SINGLET & RACE KIT
PAPRB Office – P. Paredes St. corner N. Reyes St., Sampaloc, Manila
Race Distance
2km / 4km / 7km
Non-Student / Student
Release Date: