5 K Registration Form

    Pine Mountain Lake Association
    3rd Annual 5K Run
    $25.00 registration fee covers 5K run and T-Shirt.
    Mail payment to: PMLA 19228 Pine Mountain Dr. Groveland Ca. 95321

    Registration Form On-Line Submission
    Who are you registering for this event?

    YourselfSomeone else, 18 or olderSomeone else under 18

    Your Name (required)

    Your Email (required)

    Gender:(required)

    Date of Birth:

    Emergency Contact Name

    Emergency Contact Number

    T-Shirt Size
    SmallMediumLargeX-LargeXX-Large

    Location: Pine Mountain Lake Equestrian Center 13309 Clifton Way Groveland Ca. 95321
    Date: July 1st, 2016 Time:7:00