SIRC Online Registration
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Select Which race you are paying for
Please Select
October 13- Seymour
October 20- Shelbyville
October 27- Indianapolis
November 3- Columbus
Total Payment
*
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( X )
USD
($12 per runner plus 3% processing fee)
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Runner 1
Runner 1
*
First Name
Last Name
SUBMIT
Should be Empty: