Sign Up for Our Race Series and Be an Advocate for Inclusion Join Our Family! "*" indicates required fields 1. Please select the State and Ambassadorship Location* StatesNational - No Ambassadorship NearbyAlabamaArkansasCaliforniaColoradoFloridaGeorgiaIllinoisIndianaIowaKansasKentuckyLouisianaMarylandMichiganMississippiMissouriNebraskaNew JerseyNew YorkNorth CarolinaOhioOklahomaOregonPennsylvaniaSouth CarolinaTennesseeTexasVirginiaWashingtonWashington, D.C.Wisconsin Locations 2. Name of participant* First Last 3. Name of caretaker First Last Street City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingEmail* Please enter your email address.PhoneDate of Birth* MM slash DD slash YYYY Gender*SelectMaleFemaleNon Binary4. Please select your role:* Runner Athlete Rider Guardian Angel Runner - Our runners are the athletes who have the honor of running with our Athlete-Riders in life and in endurance events. Athlete Rider - Athlete - Riders are the athletes who "Roll With the Wind" in life and endurance events. Guardian Angel - The glue that holds our Family together, Guardian Angels are volunteers that assist our runners, athlete-riders, and Ambassadors in accomplishing their objectives on event day and in life!5. If a rider, please describe your disABILITY and any medical concerns that you wish to highlight. Example: Cerebral Palsy, Downs, Autism, etc. Include any important medical needs to include; needs a chair that can hold an oxygen tank, needs to sit upright, needs cushions to keep legs elevated. 6. If a runner, please select your average not pushing 5k pace for pairing purposes* Sub 7 minute miles 7 - 9 minute miles 9 - 11 minute miles Greater than 11 minute miles Not registering as a runner Would you like to sign up an additional person on their behalf? (child, spouse, etc.)*NoYesAdditional Signup 2. Name Email 1. Please select the State and Ambassadorship Location Actions Edit Delete There are no Persons. Add Person Maximum number of persons reached. CAPTCHAWaiverBy signing I acknowledge my understanding that my participation in any Ainsleys Angels of America event and/or any pre- or post-event activities (collectively, the “Event”) involves rigorous physical activity and that it potentially may be hazardous. I attest and verify that I am physically fit and have sufficiently trained for the Event and that, if appropriate, my physical fitness to participate in the Event has been verified by a licensed medical doctor. I expressly assume all known and unknown risks associated with the Event, including but not limited to: loss of or damage to my property; injury (including death); accidents; the effects of weather; and terrain conditions that may vary widely, and that may include uneven and/or slippery surfaces, spectators, participants, and natural and manmade obstacles (including without limitation, vehicles, security barriers, signs, cables, mats, and debris on the course). In consideration of my participation in the Event, I, for myself, my heirs, executors, administrators, personal representatives, successors and assigns, waive any and all rights, claims and causes of action I have or may have against any Race Organizer that may arise as a result of my participation in the Event. For these purposes, a “Race Organizer” is any one or more of the following: Ainsleys Angels of America and their affiliates; all governmental agencies representing the territory in which the Event will be held; all sponsors, agents, vendors, and contractors of or for the Event; medical service providers; and the officers, directors, employees, representatives, successors and assigns of each of the foregoing. I hereby agree to indemnify all Race Organizers for all claims and losses (including attorney’s fees and court costs), which may be brought against any one or more of them by anyone claiming to have been injured or otherwise to have suffered loss or damage as a result of my participation in the Event. I further grant full permission to any and all of the foregoing to store, use and/or reproduce my image or likeness by any audio and/or visual recording technique (including electronic/digital) now in existence or hereafter invented, for any legitimate purpose, including commercial sales and marketing purposes. I understand and agree that information about me that is collected by the Race Organizers, including without limitation information on this form and my Event results may be disclosed to third parties for any legitimate purpose, including commercial sales and marketing purposes, and that it may be subject to re-disclosure by the recipient(s). I authorize and understand a background check will be conducted on me as part of the approval process. I authorize the release my complete arrest record. I waive such legal rights that may arise and I do release all persons and law enforcement agency from liability in connection with furnishing of such information. I acknowledge and agree to abide by any Official Rules for the Event that may be posted at the Event or on the Event’s website. I hereby represent and warrant that I am 18 years of age or older or, if applicable, that I am the parent or legal guardian of the child under the age of 18 years old who I am registering for the Event and that I have the full power and authority to agree to these terms on behalf of such child, and to bind him/her to these terms. I hereby grant full permission to any of the foregoing to use photographs, films or recordings of the event for any legitimate purpose.