Registration Form

Each participant will need to complete the registration form and click the SUBMIT button. If you are registering more than one participant, complete the form and click SUBMIT for each registration.

After all your registrations have been SUBMITTED click the Donate button to be redirected to the PayPal site. You may pay for all registrations at the same time. If you do not have a PayPal account, you may use your MasterCard, Visa, Discover, or American Express card.

Click the button to review the Waiver OR scroll down to begin the registration process.

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FIRST NAME

LAST NAME

ADDRESS1

ADDRESS2

CITY

STATE

ZIP

TELEPHONE

GENDER: (indicate gender if you wish to compare your race results with others)

AGE on day of race (indicate age if you wish to compare your race results with others)

I WOULD LIKE TO PARTICIPATE IN (if you prefer to donate without participating in the race, please click Donation Only in the field below and select No T-shirt in the Shirt Size field)

SHIRT SIZE

DONATION AMOUNT: We are requesting free will donations to participate in Kahlyn's 5K Run/5 Block Walk. The minimum donation amount expected to receive a shirt is $25 until June 5th, $30 after June 5th. In the field below, please enter the amount requested to receive a shirt plus any additional donation you wish to include. (If you wish to pay for multiple participants at the same time click the Donate button below only once after completing registrations for each participant.)

MY REGISTRATION IS BEING PAID BY: (name of person paying if other than name being registered)

By clicking this checkbox I confirm that all information entered is correct.

I am mailing my donation to the address listed below (do NOT click the Donate button)

I am registering multiple participants and have completed and SUBMITTED a registration for each (list names in Comments field).

Comment

By checking this box and entering my name below I assert that I have reviewed and agree to the waiver on the previous page.

Name

Date

Click the Submit button above to submit your registration and then click the Donate button to be re-directed to Paypal to make your payment. If you prefer to mail your payment, click Submit above and mail your payment to: Kahlyn’s 5K Run, 1065 E 450 Rd, Lawrence KS 66047

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