2011 Final Leg registration

1. Contact Information & Background

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* 1. Please enter your contact information.

Name:

Agency:

Work Address:

City/Town:

State:

ZIP/Postal Code:

Email Address:

Phone Number:

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* 2. I am a(n):

LETR Officer

SOIN Athlete

SOIN Unified Partner

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* 3. I will be participating as a(n):

Runner

Event Support staff

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* 4. What is your t-shirt size? (Check one)

Medium

Large

X-Large

2X-Large

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* 5. Select the County Torch Run that you will be participating in.

Hamilton County - May 20

Putnam County - May 20

Fayette County - May 21

Montgomery County - May 14

Allen County - May 30

Johnson County - May 31

Delaware County - June 10

Boone County - June 25

N/A

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* 6. I will be participating in the Final Leg on Friday, June 3rd to celebrate Special Olympics Indiana's Summer Games.

Marion County Final Leg starting at Victory Field

Vigo County Final Leg starting at GFS Marketplace

N/A

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* 7. I will be attending the Special Olympics Summer Games Opening Ceremonies in Terre Haute at 7pm on Friday, June 3rd.

Yes

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* 8. I understand that the event registration fee is $30 per person and is due on or before the day of the Torch Run. Participants are encouraged to raise pledges above the entry fee.

I agree

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* 9. Please enter your birthdate. (Optional)

Birthdate

Date

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* 10. Please enter your gender. (Optional)

Male

Female

Thank you for completing the Torch Run Final Leg online registration.

The Final Leg is a Special Olympics Indiana LETR fundraiser. Officers are encouraged to seek out pledges and sponsors. If you would like to use our fundraising Web site, visit www.firstgiving.com/soindiana.

Please make checks payable to: Special Olympics Indiana, Attention: Torch Run Final Leg, 6100 West 96th Street, Suite 270, Indianapolis, IN 46278.

Thank you for your support of Special Olympics Indiana and the Law Enforcement Torch Run.