Kiowa 2017 Relay for Life 5K, Bike Ride & Fun Walk

April 7, 2017

Registration at 4:30 p.m.

Race starts at 5:30 p.m.

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* 1. Please fill out the following information:

Name:

Email Address:

Phone Number:

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* 2. Which event are you registering for? Please pay entry fee on event day. Additional information about the race with be emailed or mailed to you. Children under 5 may participate for free with a registered parent or guardian.

5K Run $25.00

5K Bike Ride $25.00

1 Mile Fun Walk $20.00

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* 3. If you're already a part of a Kiowa County Relay for Life Team, what is the name of the team?

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* 4. T-Shirt Size

Youth:Small

Youth: Medium

Youth: Large

Adult: X-Small

Adult: Small

Adult: Medium

Adult: Large

Adult: X-Large

Adult: 2X-Large

Adult: 3X-Large

Adult: 4X-Large

Other (please specify)

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* 5. Please make checks payable to GPY&FS, Inc. Mail or drop payment: GPY&FS 901 South Broadway, Hobart, OK 73651

Mailed on:

Dropped payment on:

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* 6. Do you have any other comments, questions, or concerns?

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* 7. Are you a Cancer Survivor?

Yes

No