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Race Date: August 28, 2022

Location: 7401 Cimarron Park Dr 79911

Meet: 7:00 AM Start Time: 8:00 AM

Package Pick up: August 27, 2022

Location: 3945 Doniphan Park Circle 79922

Time: 10 AM- 2 PM
Participant Information
Full Name*

First NameLast Name
Age*
Birthdate

MonthDayYear
Date
Gender
Email
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

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Postal / Zip Code
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Profile Picture

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T-Shirt Size*

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Emergency Contact Details
Contact Person*

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Phone Number*

Area CodePhone Number
Relationship*
Payment Information
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Registration Fee$35.00

Total $0.00
Waiver & Release
Please check all that apply.*

I confirm that I am in good shape, health, and condition.I don't have any medical condition or medical history that will affect my participation in this eventI acknowledge that this road race requires physical activity and there are possible risks and danger.I release the road race event organizers for any responsibility in case of an accident, illness, or injury.I confirm that all information in this registration form is accurate and true.
Participant's Signature*

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Date Signed

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Date
Parent/Guardian Signature (If participant is below 18 years old)*

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Date

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Date
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