Use the form below to register for this year’s Kids and Cancer Benefit Run. If you have already registered but have not paid, please click here to complete your registration.

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Participant Name (driver)

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Last Name*

Rider (optional)

First Name
Last Name

Address

Email*
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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