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.

If you have already registered and want to order a 2021 lighter ($30), please email kidsandcancerbenefitrun@gmail.com

    Participant Name (driver)

    First Name*
    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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