FIRST ANNUAL

Light Up Columbus for AutismVirtual Glow 5k/10k

March 1st – April 18th, 2014

STEPS:1. Fill out this registration form, (use your ‘tab’ button to toggle to each field). 2. Email or mail completed form to the address listed below3. You will receive an invoice via paypal. 4. When your payment is received we will email you confirmation with your printable bib

Run Your Race!

1. You have March 1-April 18th to complete your mileage. This is based on the "honor system.”2. Have someone take you picture with your bib and lots of glow on during your race so we can post on our Facebook page. If you haven't already please "like" our Facebook page.  

https://www.facebook.com/LightUpColumbus Go ahead and get crazy! We are looking for you to light up your town for autism. 3. Email your picture to lucvirtualrun@strollerstrongmoms.com

Once you have completed these 3 easy steps we will mail you your t-shirt.

REGISTRATION FORM:

NAME (FIRST & LAST):

ADDRESS:

CITY: STATE: ZIP:

EMAIL ADDRESS:

PHONE NUMBER: - - AGE: GENDER: MALE FEMALE

SHIRT SIZE (TSHIRTS ONLY GUARANTEED FOR REGISTRATIONS BEFORE APRIL 11TH)S M L XL

Cost:Registration $20

(CHECK OR MONEY ORDER ONLY PAYABLE TO: Stroller Strong Moms)

***Preferred method of submission

*** Email form to:LUCVirtualRun@strollerstrongmoms.com

PLEASE MAIL COMPLETED FORMS AND PAYMENT TO:STROLLER STRONG MOMS, LLC

PO BOX 164ELLERSLIE, GA 31807

If you have any questions or need any information about this event, please visit us on Facebook at https://www.facebook.com/LightUpColumbus or contact Kim at LightUpColumbus@strollerstrongmoms.com

WAIVER/RELEASE STATEMENT (please read and sign below)In consideration of acceptance of this entry, I hereby for myself, my heirs, my executors, and administrators, waive any and all rights and claims for illness, injuries, or damages I may have against the Big Dog Running Co, Autism Speaks, Uptown Columbus, or Stroller Strong Moms, LLC and it’s officers, directors, and members, volunteers, employees, agents, sponsors or race director. None of the above is responsible for loss of personal items, or any form of aggravation in convection with said event. I fully understand that in doing so I assume full responsibility for all damages or injuries incurred by me in convection with this event. I give permission for the free use of my name or photograph in any broadcast or print account of this event. I am in proper physical condition to participate in this event. I certify that I carefully read this release and know the contents.

If you have any questions or need any information about this event, please visit us on Facebook at https://www.facebook.com/LightUpColumbus or contact Kim at LightUpColumbus@strollerstrongmoms.com