Use the form below to register for this year’s Kids and Cancer Benefit Run. After you submit this form you will be redirected to the page where you can make your payment.

If you have already registered and want to order a 2021 lighter ($30), please email

    Participant Name (driver)

    First Name*
    Last Name*

    Rider (optional)

    First Name
    Last Name


    Street Address Line 1
    Street Address Line 2
    City State/Province
    Postal/Zip Code

    Phone Number

    Area Code and Number

    Shirt Sizes

    Driver T-Shirt Size

    RiderT-Shirt Size (if applicable)

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