Paper Registration Form

5th Annual Stomp out Sepsis


Race Location
Lilburn City Park
76 Main Street NW
Lilburn, Georgia
Mail Form + Check To
FundRacers LLC
2217 Independence Lane
Buford, GA 30519
___________________________________
First Name		 _________________________________
Last Name
Gender:   Male     Female     Age (on 9/26/2026): ______
  First 4 Participants $92.00.
Registration:
5K $27.00  
Fun Run $18.00  
Select an event to register for.
T-Shirt Size:
Youth SM  
Youth MED  
Youth LG  
SM  
MED  
LG  
XL  
2XL add $2.00  
No T-shirt (I waited too late and my size isn't available)   
Select what size shirt .
Are you a SCCM SE Chapter Member?: ______________________________
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: ___________