Registration Form 
NOTICE
This online form may only be used by persons over the age of 13.
If you are under age 13, DO NOT proceed with the instructions below.

Request for Membership and Race Entry

Step 1

Last Name*: First Name*:        
Street Address*: City*: State*: Zip*:
Phone Number*: Best time to call*:            
Where did you hear about the Race*?            

Step 2

Select Race Event*:            


RACE RELEASE, WAIVER, AND ASSUMPTION OF RISK
In consideration of my entry being accepted, I, intending to be legally bound, do hereby for myself, my heirs, executors and administrators, waive, release and forever discharge any and all rights and claims for damages which I may have hereafter accrued to me against the City of Los Alamitos, Military Department of the State of California, USA Water Polo and Los Alamitos Aquatics Foundation, RUN Racing, and the United States of America, and all their sponsors or any other individuals, organizations or event sponsors associated with the above for any and all damages/injuries which may be sustained by me in connection with participation in and returning from the Los Alamitos Race on the Base. I further attest and verify that I am physically fit, enjoying good health and have sufficiently trained for the competition of this race. I will additionally permit the publication of my/my child’s mane and picture in newspapers, websites, and/or brochures related to this event. I further give Southland Credit Union permission to provide Race on the base with my personal information needed to register for the Race on the Base. * Required Fields