29
th
Annual High Mountain Coffee 10-k and 5-K Road Races
General Information
Event to Participate in:
Walk
5 - K
10 - K
Last Name:
First Name:
Gender:
Male
Female
Other
Date of Birth (DOB):
/
/
eg. (01/31/2011)
Age at race day:
Contact Information:
Street:
City:
Country:
Email:
Telephone:
Type of Entry:
(Select option that you wish to enter)
Option A:
<Select>
individual
Option B:
<Select>
Wheelchair
Option C:
<Select>
High School Team
Name of Club/ School:
T-Shirt Size:
Small
Medium
Large
X-Large
Championship number:
Emergency Contact:
Last Name:
First Name:
Phone Number:
Relationship:
Medical Condition (if any)
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