REGISTRATION FORM - BIG HUMP 2005 GREEN DRESS RUN



Hash Name:
Home Hash:
  
Nerd Name:
Address:
City:
State:
ZIP:
  
Phone: (123-123-1234)
E-mail:
  
  
I want it all! ($55.00) What a deal!!!
Friday night social only for me thank you.($10.00) You're on your own for drinks though.
I am cheap and lazy. ($30.00) Saturday's run and the on-after only. (no t-shirt)
Pregnancy Rate.
  
  
I'd like to pay via PayPal using my major credit card (no PayPal account required!).
I'll need instructions for mailing a check.
I already paid via your PayPal link.
I already gave/sent a check.
  
  
T-Shirt Size:
M
L
XL
XXL
  
  
CUSTOMARY DISCLAIMER

I hereby release the Hash House Harriers from any responsibility for any injury, death, debt, pregnancy, or any other misfortune which may befall me related in any way to my participation in this event. In other words, if I get hurt, it's my own stupid fault.

By checking this box, I signify that I have read, understand, and agree to the "Customary Disclaimer" above.