2nd Annual Time In A Bottle 5K Walk/Run Registration Form

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Please fill out the following form to register for the 2nd Annual Time In A Bottle 5K Walk/Run at the La Purisima Mission in Lompoc, California.

The registration fee is $10 to support the event and the La Purisima Mission.

ALL are welcome!

Email *

Full Name *

Age Group *

1-13

14-19

20-33

34-49

50-65

66-75

76+

Male/Female *

This information is only used for medal grouping.

Male

Female

Other:

Are you registering to run or walk? *

Run

Walk

T-Shirt Size (Unisex) *

XXL

Registration Payment Details

A $10 registration fee is required for ages 14+ in support of the event and the La Purisima Mission. This can be paid through Paypal to Danielle Seelandt @DRodgers48

Please also register your participants under 14 years of age, but no fee is required.

If you need an alternate way to pay, please contact Danielle at (661) 803-5432.

If you are unable to make the payment, we still invite you to participate in remembrance of Mary Lou and Karl Seelandt and their love for running at the mission!

Payment *

I have paid the $10 registration fee through PayPal

I have paid the $10 registration fee through seelandtfamilyfoundation.com via donation

I will pay $10 cash upon arrival

I am not able to pay $10 but I still want to join

I am registering a child under the age of 14, no payment needed

Parking Details

PARKING:
Day Use entry is first come, first serve. Park Day Use shall apply to all vehicles:

Regular - $6.00

Senior - $5.00

There is free parking on the dirt road across the street from the mission.

Other Information

PETS:

Pets are welcome but they are your sole responsibility. The Seelandt Family Foundation and the La Purisima Mission are not responsible for damage caused by any pets.

SMOKING:
Smoking is not permitted in or within 20 feet of any buildings.

We request no smoking around the event route or meeting area.

Is there anything else you would like us to know or any questions you have?

Event Registration Completion

Your registration is not fully complete until the day you arrive at the event. We will confirm all of your details and provide you with your running bib so we can track your time!

If you would like to donate to the Time In A Bottle 5K or The Seelandt Family Foundation please visit seelandtfamilyfoundation.com or check out our Amazon List: https://www.amazon.com/hz/wishlist/ls/1OWQ8LZW4H18K?ref_=wl_share

All our love,

The Seelandt Family

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