Click here to register online before Thursday, June 21, 2012.
You may also print and mail the form below. Form must be received my Thursday, June 21. 2012
Individual/Runner Name Male Female Age
Street Address Birthdate
City State Zip
Signature
Team Name if applicable
Biker's Name Male Female Age
Swimmer's Name Male Female Age
Shirts are Adult Sizes, S , M , L , XL , XXL
If this is a team registration, please indicate the number of each size needed.
FEES:
Make Checks payable to: West Union Park and Recreation
To ensure a t-shirt on race day, forms must be received by June 1, 2012.
Print this page and mail with check to:
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