Individual Information:

Accepting Visa, Mastercard, and Discover
First Name: 
Last Name: 
Address: 
Address 2: 
City: 
State
Zipcode: 
Country: 
Email: 
Emergency Phone Number: 
Sex: 
USATF number (optional): 
Age (on race day) 

Race: 
Police, Firefighter or Active Military: 

5k Best Time (Only required for 5K run/walk) Minutes: Seconds:
If left blank, you will be in the LAST wave of runners
Enter total 5K time (3.1 miles). Not per mile pace.

Tickets for Pasta Dinner with Bill Rodgers 4 time Boston Champion and Geoff Smith 2 time Boston Champion. May 3rd Snowden Hall, Johnson and Wales Campus, Weybossett St, Providence. Limit on tickets
Number of Tickets. ($15.00/each):
Seating Time:

Optional: Additional Amount for Charity $ Charity Donation to:

Waiver: In consideration of the acceptance of this entry, I hereby for myself, heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against Cox Communications Inc. and its affiliates, Johnson and Wales University, the City of Providence, the City of Pawtucket, the City of East Providence, Eident Sports Marketing, the state of Rhode Island, USATF, sponsors, race officials, organizers, and volunteers associated with this event for any injury that may occur as a result of my participation in this event.

Check this button if you agree to this waiver