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Online 5k Run/Walk Registration Form

Registration Fee..............$ 20.00 per person   

  • Register online OR mail completed registration form and payment to:
    Mike Bruns c/o Helias Foundation, 1305 Swifts Hwy, Jefferson City, MO 65109
  Printable Registration Form Available for Download Here
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Email:
Date of Birth: / /
Age:
Gender:
     
T-Shirt Size:

  AMOUNT DUE: $
 
I have completely read and agree to the following.
I acknowledge and represent that I am physically fit and sufficiently trained to participate in an event of this nature. I accept full responsibility for any injury or accident resulting from my participation in this event and release from any and all liability Helias High School, Helias Foundation Incorporated, the City of Jefferson and all race sponsors and any race officials.
 

Your registration is not complete until you enter your credit card information on the next step.

Online Payment is made via a Secure Server


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