2015 Art of Women's Health 5K Run/Walk Registration Form

ONLINE REGISTRATION IS NOW CLOSED. BUT, PLEASE, MEET US AT THE LION'S CLUB PARK. YOU CAN REGISTER THERE!

Friday, April 27, 2018 ~ Registration at 5:00/Yoga at 6:00 pm

$10 Entry Fee (includes yoga mat and wine glass)
Event will take place in the Lion’s Club Park.
Three yoga instructors will demonstrate different forms of yoga:
Debbie Ramer, Mary Haynes and Stephanie Haas.
Afterwards, participants are invited to take part in Ste. Genevieve’s 4th Friday Art Walk festivities. Register online or pick up a registration form at the Women’s Wellness Services at Ste. Genevieve County Memorial Hospital, Pointe Basse Plaza or Bloomsdale Medical Centre. For more information, call 573-883-4402.

Name * (Name is required)

Address * (Address is required)

City * (City is required)

State * (State is required)

Zip Code * (Zip Code is required)

e-mail * (e-mail is required) (e-mail must be a valid email address)

Phone Number * (Phone Number is required)

Age * (Age is required)

Sex*

Male

Female

Emergency Contact Name * (Emergency Contact Name is required)

Phone Number * (Phone Number is required)

By submitting form:
1. I understand that participating in an exercise event involves risk of injury; I agree to be solely responsible for any injuries sustained by me as a result of my participation in this event.
2. I understand that it is my responsibility to consult with a physician prior to and regarding my
participation in this Yoga demonstration event. I represent and warrant that I am physically fit and have no medical conditions that would prevent me from participation in this event. I assume full responsibility for any injuries or damages, known or unknown, which I might incur as a result of participating in this event.

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ONLINE REGISTRATION IS NOW CLOSED. BUT, PLEASE, MEET US AT THE LION'S CLUB PARK. YOU CAN REGISTER THERE!

Friday, April 27, 2018 ~ Registration at 5:00/Yoga at 6:00 pm

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