REGISTRATION FORM Deadline: Entry fee includes t-shirt, care package and breakfast. I cannot participate, but would like to make a donation $_______________ I cannot participate, but would like to sponsor the Individual named below Individual Adult (15 and up) $ 30 Individual Youth (14 and under) $ 20 Family registration $ 80 TOTAL AMOUNT ENCLOSED $______________ Please make payment by (note: “Dash for Attn: Dash for 500 N Cherry PARTICIPANT/FAMILY LAST NAME_____________________________________________________ If sponsoring a participant, please indicate your full name and address here; list participant name below. Name__________________________________________________________________________________ Address_______________________________________________________________________________ City_____________________________________________State________________Zip_____________ Email__________________________________________________________________________________ I would like to have my time tracked PARTICIPANT NAME(S) (as of 1____________________________________ _____ M F 2____________________________________ _____ M F 3____________________________________ _____ M F 4____________________________________ _____ M F T-Shirt sizes (if registering as family, please indicate number per size; total number not to exceed 4) Adult: _______S _______M _______L _______XL _______2X Youth: _______S _______M _______L Please see next section for Release and Assumption of Risk which must be signed and accompany application.
(Includes 4 t-shirts and care packages)
