Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

How do you want to pay? (after submitting this form, you will be directed to a payment page.) *

Check - mail it now

Check - pay on day of trot

Credit Card - pay now (please click the DONATE button after submitting this form)

Which are you trotting in? (please check one) *

5K

1-mile Fun Run

I am not trotting - please mail me a Tshirt ("out of towners" only)

I am not trotting - will pick up my T-shirt at the trot

TSHIRT (select a size; women's run small) *

adult uni XXL

adult uni XL

adult uni L

adult uni M

adult uni S

womens L

womens M

womens S

child 12

child 10

child 8

child 6

child 4

child 2

I do not want a tshirt