Organized by ifm efector Orange Run Registration/Donation Form Please fill out the form below to register for the Orange Run. Registration will open at 5:45 pm on the day of the Run, Thursday, July 20, 2017. Registration and the race begin at ifm efector located in Atwater Business Park, 1100 Atwater Drive, Malvern, PA. Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Enter Email Confirm Email Age*Birthday* Entering as:*IndividualFamily (3 or more)I just want to donate to The Breathing RoomFamily DetailsFamily (3 or more):* Price: $60.00 Registration will open at 5:45 pm on the day of the Run, Thursday, July 20, 2017. Registration and the race begin at ifm efector located in Atwater Business Park, 1100 Atwater Drive, Malvern, PA.Family Name:*Number of Other Family Members Running (Excluding Yourself)*OneTwoThreeFourFiveSixSevenEightNineYour Running DetailsGender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5k Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Type name to accept wavier:*Family Member OneName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member one type name to accept wavier:*Family Member TwoName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member two type name to accept wavier:*Family Member ThreeName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member three type name to accept wavier:*Family Member FourName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member three type name to accept wavier:*Family Member FiveName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member three type name to accept wavier:*Family Member SixName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member three type name to accept wavier:*Family Member SevenName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member three type name to accept wavier:*Family Member EightName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member three type name to accept wavier:*Family Member NineName* First Last Age*Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*5K Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Family member three type name to accept wavier:*Individual DetailsIndividual Registration:* Price: $25.00 Registration will open at 5:45 pm on the day of the Run, Thursday, July 20, 2017. Registration and the race begin at ifm efector located in Atwater Business Park, 1100 Atwater Drive, Malvern, PA.Gender*FemaleMaleShirt Size*Women's SmallWomen's MediumWomen's LargeMen's LargeMen's Extra LargeParticipating in:*Start time is 6:30 pm on Thursday, July 20, 2017. Race begins and ends at ifm efector located at 1100 Atwater Drive in Atwater Business Park, Malvern, PA. Registration is 5:45-6:30pm.5k Run2 Mile WalkIn consideration of my being permitted to participate in the Orange Run (“the Event”), on my own behalf and for my personal representative, assigns, heirs and next of kin, I hereby release, waive, discharge and covenant not to sue ifm efector inc., its employees, its affiliates and subsidiaries, as well as their assigns, agents, attorneys, heirs and next of kin, and the Breathing Room Foundation, from and for all liability, any and all loss or damage, and any claim or demands therefore, on account of injury to person or property, illness or death, suffered by me, whether caused by negligence or otherwise, arising out of or relating to my participation in the Event. I am aware that running or walking is potentially hazardous and I assume all risks associated with participating in the event, including, but not limited to: falls, contact with other participants, effects of the weather including high heat and humidity or extreme cold, traffic and conditions of each course, all such risk being known to me. I am 18 years of age or older and I am competent to contract in my own name, or, as indicated below, have signed authorization of a parent or guardian who consents to the terms herein.* I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver and release. Please type name to accept wavier:*Make a DonationDonation Amount* Payment InformationCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Total $0.00 EmailThis field is for validation purposes and should be left unchanged.
