*Fields with asterisks are required.
**Registration confirmation will be sent via email.

PERSONAL INFORMATION

First Name *	Last Name *
Address *	City * State *
Country * Phone *	Birthdate M/D/YY * MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10111213141516171819202122232425262728293031 YYYY 200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950
Gender * Female Male
Email * *	Confirm Email *
Nationality *	Passport Number *

EMERGENCY

Contact Name *

Contact Phone * Contact Relationship *

RACE

Distance * 42Km 21Km 10Km 5Km	Estimated Running Time *
Previous Pacasmayo Marathon Participant? * Yes No
Shirt Style * Short Sleeved Sleeveless
Shirt Size * Small Medium Large Extra-Large

Running Fact About You *

How did you hear about the Pacasmayo International Marathon? * Website Newspaper Radio Television Brochure Friend Other

I have read, understand and agree to the liability waiver.

Event Registration Online for Pacasmayo International Marathon 2012 powered by Eventbrite