Jersey Shore Hospital
Run Toward a Cure - Registration Form  VIEW THE COURSES!  5K Course Map     10K Course Map

Jersey Shore Hospital's Run Toward a Cure "Miles of Memories" 10K, 5K, & Kids' Fun Run at Nippenose Bible Fellowship Church in Oval. All proceeds will go to the Northeastern PA Affiliate of Susan G. Komen. Registration starts at 7:45am. Opening ceremonies start at 8:45am. The race starts at 9am.

Registering For :
First Name :
Last Name :
Address :
City :
State :
Zip :
Phone Number :
Email Address :
Age :
Gender :
*Tee Shirt Size :
Payment :
Release & Consent Form: In consideration of the acceptance of my entry/my child;s entry, I for myself or my child do hereby release and discharge the organizers of this race and all other sponsors and organizers of all claims and damages, actions, whatsoever in any manner arising out of my/my child's participation in said event. I attest and verify that I have full knowledge of the risks involved in this event and I child is physically fit and sufficiently trained to participate in this event. Further, I hereby grant full permission to all of the foregoing use to use my/my child's name, photographs, videotapes, recordings or any other record of this event for any legitimate purpose without compensation or remunerations.
  I have read the release and consent above and I Agree  

Please Make Checks Payable to: Jersey Shore Hospital

5K Course Map

10K Course Map

Cost for pre-registration is $20.

Day of the event registration is $25.

Send Registration Forms and/or Checks to:
Brock Trunzo
Jersey Shore Hospital
1020 Thompson Street
Jersey Shore, PA 17740

*All participants will receive a t-shirt. Those who pre-register will have the opportunity to pick their own size.
Anyone registering the day of the event is not guaranteed a shirt in their size.

All proceeds will go to the Northeastern PA Affiliate of Susan G. Komen.

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