PRE-REGISTRATION ENTRY FORM
QuickCharge program explained .
All pre-registration fees must be RECEIVED by June
IF YOU DO NOT RECEIVE AN ENTRY
CONFIRMATION BY E-MAIL WITHIN 24 HOURS, PLEASE CALL NCN RACING AT 440-366-0645 TO NOTIFY THE RACE DIRECTOR.
Race Name: JUNE
29TH COLUMBIA STATION HALF MARATHON RUN & INLINE SKATE
Phone Number (nnn-nnn-nnnn)
Date of Birth (mm/dd/yyyy)
Age on June
Event you would like to enter
Half Marathon Run
Half Marathon Skate
Division in which you will compete
Clydesdale (Male 200 lbs +)
Athena (Female 140 lbs +)
PRE-REGISTRATION FEES - Payable by June 25, 2014 - Select One Below
The pre-registration fee for the Half Marathon is $50.00 US.
The pre-registration fee for the Half Marathon with no T-shirt is $47.00 US.
(The day-of registration fee for the Half Marathon with
no T-shirt is $60.00 US.)
Half Marathon Inline Skate
The pre-registration fee for the Half Marathon Inline Skate is $50.00 US.
The pre-registration fee for the Half Marathon Inline Skate with no T-shirt is $47.00 US.
(The day-of registration fee is $60.00 US.)
PLEASE NOTE: The "No-Shirt" option is available for pre-registration ONLY.
Day-of entrants will get a price reduction for not receiving a shirt, but they will
pay a slightly higher fee to race. T-shirts guaranteed ONLY for first 100 entries!
T-Shirt Size (or "No Shirt" option in drop-down list)
How do you wish to pay for your entry?
Online (Credit Card)
By Telephone (Credit Card)
By Standard US-Mail (Credit Card)
By Standard US-Mail (Check)
With NCN Gift Certificate
With Volunteer Voucher
With NCN Rain Check
If you are mailing in a check, please make it payable to
If you are redeeming a gift certificate, please type in the certificate # here.
Please note: All rain check balances
are stored in our database, and will be applied accordingly, but if you need to
know your balance, please
e-mail Rick, or call him at (440)366-0645.
If you intend to pay by gift
certificate, volunteer voucher, or call in your credit card or checking information,
you have completed this form. Please skip to the WAIVER section. If you wish to
use our secure server for your credit card or checking transaction, please fill
in the following fields, then click on the SUBMIT button.
1. Credit Card
Name (as it appears on card)
Billing Address: Street
Billing Address: City
Billing Address: State
Billing Address: Zip/Postal Code
Credit Card Number
Expiration Date (nn/nnnn)
Card Verification Value
(3-digit number on back of card)
2. Checking Account
Please read, then check "agree" or "disagree" (required field) below to complete this form.
In consideration of NCN Racing,
and all sponsors, permitting (me) or (my
child) who is under 18 to participate in the above named event, I hereby and for (me) or (my child’s) heirs,
executors, administrators, and/or assigns, waive and release any and all rights and claims of any nature
that (I) or (my child) may have against NCN Racing, all sponsors, and their officers, employees, agents, executors,
administrators, successors, and/or assigns for and against any and all injuries or damages of any nature
which (I) or (my child) may suffer while taking part in any activities connected with this event. The
release and consent shall be binding upon (my) or (my child’s) heirs, executors, administrators and/or assigns.
Agree to waiver:
I do not agree