Diabetes Fun Run/Walk

Running the Race Against Diabetes - November 2021

Registration for November 2021 Fun Run/Walk to bring awareness to Indeginous Communities in NM. Please fill out All information on registration, we will have a small gift for everyone as well as a special "gift" at the end of the Run/Walk for those who reach their goals. Please include your email.

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* 1. Name of Participant

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* 2. How Old Is Participant?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 3. What is a good email for you?

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* 4. Are YOU Diabetic?

Yes

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* 5. Would you like more information on Diabetes? if Yes we will contact you for more information.

Yes

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* 6. Do you have a Goal in mind for this Fun Run/Walk? (How many miles would you like to complete for the month of November)

Yes

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* 7. If Yes, What is your Goal? (how many miles would you like to complete in the month of November?)

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* 8. What is your address, we will be mailing out your gift and bib.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address