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KLR 3 for the 4th Race Registration Form

* Who are you registering for this event?

Yourself
Someone else, 18 or older
Someone else under 18

Participant

First Name:
Last Name:
Male Female
Date of Birth (mm/dd/yyyy) :
Age on race day:
Address:
City:
State:
Zip:
Phone:
Email:
Emergency Contact Name:
Emergency Contact Phone:
Race Selection: 5K 10K
Shirt Size: Small Medium Large X Large
Signature: (Please type in your name)