ConnecT1D · 2017 ConnecT1D All Alpha No Beta Registration

Contact Information

Name

*

First Name

Last Name

Birthday

(mm/dd/yyyy)

Phone

Email

*

Verify Email

*

Address (Where we can send you the medal after your 5K!)

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Gender (for race division purposes only)

*

Male

Female

I would prefer to not answer (this will disqualify participants from any gender division awards)

What is your connection to Type 1 Diabetes?

I have Type 1 Diabetes

I have a family member with Type 1 Diabetes

I have a friend with Type 1 Diabetes

I have no connection to Type 1 Diabetes

How did you hear about this event?

I did the Virtual 5K last year

ConnecT1D website (connect1d.org)

Facebook

Twitter

Enewsletter

Family Member/Friend

Other

How do you plan to participate in the 5K?

What is your preferred method of 5K?

I plan to join ConnecT1D at Magnuson Park on November 19

I plan to run on my own sometime in November

I would like to find a group to run/walk with in my neighborhood

Liability Waiver

*

By checking this box, I understand that ConnecT1D is not responsible for any injury that may occur during this event. I agree that I am medically able and properly trained to complete the event on my own. I hereby release ConnecT1D, its partners and affiliates, from any and all liability/claims arising from participation in this event.

Race Entry Fee

*

$25 - All funds, after race expenses are covered, go towards 2018 ConnecT1D programs

Optional Additional Donation - if you would like to further help ConnecT1D grow

$5

$10

$