2026 Miles for Mammograms Entry Form
Register for the Chief Joseph Days 5K event. Please complete all required fields and accept the waiver to participate.
Name
First Name
Last Name
Mailing Address
*
City
*
State
*
Zip
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
T-Shirt Size
*
Please Select
S
M
L
XL
XXL
Would you like to register additional people
Yes
No
How many people?
Please Select
1
2
3
Name
First Name
Last Name
Shirt Size
Please Select
Small
Medium
Large
XL
XXL
Name
First Name
Last Name
Shirt Size
Please Select
Small
Medium
Large
XL
XXL
Name
First Name
Last Name
Shirt Size
Please Select
Small
Medium
Large
XL
XXL
I agree to the terms of the event waiver
*
I agree
Participant Signature
*
Date
*
-
Month
-
Day
Year
Date
My Products
*
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Miles For Mammograms Entry
$35.00
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
Dog Entry
Proceeds go to the Wallowa County Humane Society
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Submit Entry
Submit Entry
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