LMSA Midwest: Dia de los Muertos 5K Registration Form

LMSA Midwest: Dia de los Muertos 5K Registration Form

Welcome to the registration page for LMSA Midwest's Dia de los Muertos 5K Fundraiser! LMSA Midwest is a 501(c)3 organization that is independently ran by medical students working towards improving the health and well-being of LHS+ populations across the country through education, connection, and advocacy. We are excited to host a virtual 5K to help us continue to achieve these goals and work towards our mission!
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Institution
LMSA/LMSA PLUS Chapter (if you are not in an LMSA/LMSA PLUS Chapter, write N/A in the field below)
As part of our event, we will be giving runners the opportunity to dedicate their race to a deceased loved one and include their name and photo as part of our virtual altar on our social medias. I consent to participating in the Virtual Altar on LMSA Midwest's social medias which may include the image and/or name of the person that I have submitted on this form.
If you answered yes to the above consent, please include the image of the deceased loved one you would like included in the virtual altar. If you answered no, we will not be able to include them.

Cancelof
If you answered yes to the above consent, please include the name of the individual you would to be included in the virtual altar. If you answered no, we will not be able to include them.
Event T-Shirt Fundraiser

Want to support the event and rock some LMSA gear? You can purchase an event T-shirt separately through our fundraiser! Visit here to purchase: https://bit.ly/lmsa5ktshirts
Please verify that you are human

5K Registration Fee

5K Race Entry

Entry fee for one participant in the 5K race.

$30.00

Total

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LMSA Midwest: Dia de los Muertos 5K Registration Form

Event T-Shirt Fundraiser

5K Registration Fee*

5K Registration Fee