Name *

First Name

Last Name

Phone *

(###)

###

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Registration *

Earlybird Registration ends December 10, 2024.

Student Registration Earlybird....$800.00

Adult Registration Earlybird....$1800.00

Student Registration After December 10....$1000

Adult Registration After December 10...2000.00

Adult Group Registration $1500.00

Teams *

Please check in the box the team you would like to join, and circle the event

Pink - Pink Run for Marilyn

Yellow - Hope for Tomorrow -Regina Montague

Red - FIT 4IT - Tow Tow

Purple - Children are Royalty -

Blue - Ocean Lovers/Blue Economy

Event

Please check your event

Event 5k Walk

Event 5K Run

Event 10K Run

Age Range Category

Please select one

12 - 18 years

19 - 29

30 - 39

40 - 49

50 - 59

60 - 69

70+

Emergency Contact Name *

First Name

Last Name

Emergency Contact Number *

(###)

###

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Indemnity *

I have read and agree to the indemnity found on RunWalk Indemnity Page.

Parent Release Signature for Minor

By printing your name, you are authorizing consent for your child to participate.

First Name

Last Name