Paper Registration Form

1st Annual Bill Black Memorial 5K


Race Location
Anywhere USA
walking in groups, while wearing race shirts and following CDC guidelines is encouraged
Print Form - Bring To Race
Check, Credit Card, Cash,
Venmo, and Apple Pay are
accepted at race check-in.
___________________________________
First Name		 _________________________________
Last Name
Gender:   Male     Female     Age (on 11/7/2020): ______
Referral: ______________________________
If anyone referred you to this event, type their name here.
Fundracers' "Agreement and Waiver", "Privacy Policy" and "Terms of Service" can be viewed and printed by visiting http://policies.fundracers.org online.

By signing below, I acknowledge that I have...
  • Reviewed and agree to FundRacers' "Agreement and Waiver"
  • Reviewed and understand FundRacers' "Privacy Policy"
  • Reviewed and agree to FundRacers' "Terms of Service"

Signature: __________________________________________  Date: ___________