Registration Test Name* First Last Gender*MaleFemaleT.Z./Passport Number*Birthday*I want to run/walk/skip the:*Full Marathon - 42.195 kmHalf Marathon - 21 km10K Race5K Race1.7K Family RaceContact InformationCell Phone*Home Phone*Email* Address* Street Address Address Line 2 City Additional InformationShirt Size*Extra SmallSmallMediumLargeExtra LargeFundraising Goal*Recommended minimum goal is $500How did you hear about Team Crossroads?*I'm running for Team Crossroads because...*Emergency ContactEmergency Name*Emergency Number*DeclarationI hereby declare that I am healthy and fit to participate in the race. That I have suitably trained, and my physical condition has been examined and confirmed by a certified physician. I hereby forgo any claims of responsibility towards Amutat Tzomet (Crossroads) regarding any injury I may incur, including physical injuries before, during, or after the race, and including any property damages, and/or loss of personal equipment I may incur. I, the undersigned, declare that I will not pursue any claim for compensatory damages against the above mentioned parties I hereby agree that the marathon headquarters, the sponsors of the Jerusalem marathon, and the municipality of Jerusalem, may use the pictures in which I appear during the marathon, before and after, for public relations purposes and they also may broadcast parts of the marathon and/or in whole on any existing broadcasting medium or that will exist in the future (television, internet, cellular and/or any other medium) without compensation.Confirmation* Please check this box to confirm the above Please fill out below if you are under 18Parental Approval For participants aged 18 and under I, the undersigned, do hereby allow my son/daughter to participate on the Jerusalem Marathon racesFor runners under 18, send this signed form to fax number - Outside Israel: +972-2-624-6265/ In Israel: 02-624-6265 The registration process will be completed when you call 02-624-6265 to verify that the form has been received.Coupon Registration Fee** Price: ₪ 100.00 The Registration fee for Team Crossroads is 100 NIS and will be your first donation and sponsorship to our team. Total Payment Via Paypal ₪ 0.00 CAPTCHA