5k Walk/Run/Ride Captain Sign-Up

Type Name of Team Here *

Name *

City *

State *

Zip *

Phone *

Email Address *

Age *

Gender *

Male

Female

It is $15.00 per person for team registration, with a minimum of 10 people. Team registrants will not receive event t-shirts. If you would like to receive a t-shirt the fee is $20 per person. You are welcome to donate more if you would like. Just enter an amount greater than $150.00. Once your team is registered, your team members can register individually. If you only paid for 10 team members at $150, any additional team members over 10 will have option to pay $15 when they register. *

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *