Run for Retrievers Crewmember Info 9th Annual DFW RUN FOR RETRIEVERS Registration Saturday, October 13, 2018 Canyon Falls Welcome Center 6950 Canyon Fall Drive Argyle, TX 76226 We are excited to have you and your family participate in this great cause. Crewmember registration will be paid by Raising Cane's. You may also register your immediate family members here, and the cost for them will be payroll deducted from your October 23rd paycheck at a cost of $20 per adult ages 13 and over and $10 per child ages 5 - 12. Children ages 4 and under are free. As we are printing custom shirts for all our participants, please be sure you only register if you are sure you can join us on October 13th. Question Title * 1. Please select your Restaurant: (Required.) C21 C43 C69 C70 C71 C76 C81 C82 C83 C85 C87 C90 C94 C95 C96 C97 C98 C101 C111 C117 C123 C128 C152 C154 C155 C156 C173 C174 C181 C196 C198 C199 C213 C215 C217 C226 C227 C234 C279 C280 C286 C295 C303 C313 C325 DRSO Please note the information being collected is based on the registration form provided by the DFW Labrador Retriever Rescue organization and will be used for group registration purposes only. Question Title * 2. Please enter your Legal first and last name: (Required.) First Name: Last Name" Question Title * 3. Please enter the last 4 digits of your social security number. (Required.) Question Title * 4. Please enter your home address, including city/state/zipcode. (Required.) Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Question Title * 5. Please enter your gender (Required.) Male Female Question Title * 6. Please enter your e-mail address. (Required.) Question Title * 7. Please enter your date of birth. (MM/DD/YYYY) (Required.) Date of Birth: Date Question Title * 8. Please indicate your preferred T-Shirt Size. (Required.) Youth S Youth M Youth L S M L XL XXL XXXL Question Title * 9. Emergency Contact Name: (Required.) Question Title * 10. Emergency Contact Phone Number: (Required.) Question Title * 11. Do you want to be timed? (Required.) Yes No Question Title * 12. Do you have any family members to register? Please note that the cost per family member will be withdrawn as a payroll deduction from your October 23, 2018 paycheck, and the cost is:$20 for an adult (13+ years old)$10 for a child (5-12 years old)FREE for children ages 4 and under (Required.) Yes No Next