Miles 4 Minds Registration

Miles 4 Minds

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Primary Contact Name*

First Last

Primary Contact Email*

Registration Information

*All participants ages 6+ who register by the beginning of May are guaranteed a T-shirt. T-shirt availability is not guaranteed after this date and may be limited or unavailable on the event date.

Ages 0-5

Price: $0.00

Does not include T-shirt

Ages 6-18

Price: $5.00

Includes T-shirt*

Ages 18+

Price: $10.00

Includes T-shirt*

Participant Information

Include information for each participant.

Participant #1 Name

First Last

Participant #1 Email

Participant #1 T-shirt Size

Participant #2 Name

First Last

Participant #2 Email

Participant #2 T-shirt Size

Participant #3 Name

First Last

Participant #3 Email

Participant #3 T-shirt Size

Participant #4 Name

First Last

Participant #4 Email

Participant #4 T-shirt Size

Participant #5 Name

First Last

Participant #5 Email

Participant #5 T-shirt Size

Registering 5+ participants? Please list additional names, emails, and T-shirt sizes below.

Payment Information

I would like to pay by:*

Invoice

Send Check in Advance

The Primary Contact will receive a registration confirmation email with payment instructions upon receipt of this registration form.

If applicable, Invoice Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please contact me…

If you would like to discuss being a sponsor for this event, make an in-kind donation or have a question, please let us know how we can be of service.

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