Robert Community House 5K Run for Roberti Registration

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Email *

example@example.com

Number of Runners *

$35 per person or $120 for a family pack of 4

Runner #1 Name

First Name Last Name

Runner #1 T-Shirt Size *

Runner #2 Name

First Name Last Name

Runner #2 T-Shirt Size *

Runner #3 Name

First Name Last Name

Runner #3 T-Shirt Size *

Runner #4 Name

First Name Last Name

Runner #4 T-Shirt Size *

Total Runners Registration Fees *

T-Shirt Pick-Up Options *

Pick up at the Roberti Community House, 919 8th Street, Waukegan, IL: 5/31-6/10 (Mon-Fri, 9am to 4pm) I'm out of state and need my t-shirt shipped (there is an additional $5 fee for shipping). I have arranged a different pick up with Roberti Community House.

Please provide the address where you would like your t-shirt(s) shipped? *

Same address listed above Different address

T-Shirt Shipping Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Shipping Fee *

Total Runners Registration Amount *

How Would You Like to Pay for Your Registration? *

Check Venmo PayPal

Please make your check payable in the amount of {totalRunners} to "Roberti Community House", add "5K" to the memo line and mail your check to:

Roberti Community House
P.O Box 65
Lake Forest, IL 60045

Please make your payment in the amount of {totalRunners}, add "5K" to the memo and pay via Venmo by scanning the QR Code below:

Please make your payment in the amount of {totalRunners} via PayPal.

Total Donation

Total Amount to Pay via PayPal

USD Description

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Runners

T-Shirt Pick-Up

Total Registration Fees