RACE REGISTRATION

25th Annual Race Registration

Should you decide to mail the registration, our address is 2437 Welch Blvd, Flint MI 48504

* Indicates required field

First Name *

LAST NAME *

MIDDLE INITIAL *

Cell Phone *

Home Number *

Other Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

OCCUPATION *

EMERGENCY CONTACT NAME *

EMERG. PHONE *

COMPANY YOU ARE RUNNING/WALKING FOR? *

Please write down your shirt size *

HOW DID YOU HEAR ABOUT OUR CLINIC? *