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Registration Information
Racer Name
*
Racer Age
*
Registration Type
*
$25
-
Adult Registration
$15
-
Kid Registration (17 and under)
Your Contact & Billing Information
Name
*
First Name
Last Name
Email
*
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*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
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Additional Donation
$
Will you be bringing a leashed dog?
Yes
No
Add 3% to my total amount to help cover the payment processing fees