Relay WebPage R3 minus text

 

 Supported By:

 

 

NOTE:

  Each runner must complete a registration form (with waiver) for each entry,

even if the runner is participating in multiple divisions.

Send this link to your teammates to submit their registration. You may make a single payment for multiple entries ($30 per entry).

 

Questions or trouble registering? Call 434-972-1701

 

United Way Relay Registration

Asterisk denotes required field.

NOTE: If you are paying for a team, but not registering yourself to race, please call the United Way office at 434-972-1701 to submit payment.

Registrant Contact Information

Registrant Name (First and Last)(*)
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E-mail(*)
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Registrant Phone(*)
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Registrant Address(*)
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Registrant Address 2
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Registrant City(*)
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Registrant State(*)
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Registrant Zip Code(*)
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Tshirt Unisex size(*)
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Enter your Age(*)
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Team Information

Team Division(*)
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Team Name(*)
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List your Team Affiliation (Company name, etc.) here if different than your Team Name.

Team Affiliation
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List other team member names, including first and last names. If team members are unknown, list TBD. Please note: Listing other team member names is for tracking purposes only. This does not constitute registration for any other team member. Send the link at the top of this page to other team members for their registration.

Other Team Member #1(*)
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Other Team Member #2(*)
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Other Team Member #3(*)
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Electronic Waiver

Read through the entire agreement.

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*I have read and agree to these terms. Enter your name below as signature. Note: Parent or guardian must sign for any child under 18 years old.

Type your name here(*)
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Registration Payment

NOTE: Entries are not confirmed without payment ($30/entry).

Enter Promo Code, if applicable
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Enter the number of race entries to be paid now(*)
Must be a numeric value.

Enter the names of any additional participants (and/or divisions if you are running in more than one) included in this payment.

Additional Participant(s)
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If someone else is paying for your registration, enter $0 for Total Registration Payment, then list the person or business name.

Total Registration Payment(*)
Please enter your numerical
amount, with no commas
or dollar signs.

Payer Name
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I'd like to make an additional donation to support access to healthcare. Additional donations are tax-deductible.

Enter additional donation
Please enter your numerical
amount, with no commas
or dollar signs.

Enter the total payment amount, including all payments for race registrations and any additional donation.

Total payment:(*)
Please enter your numerical
payment amount, with no commas
or dollar signs.

Additional comments?
Please enter at least one attendee name.

Billing name/address same as Your Information?
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Name On Card(*)
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Billing Address (Street)(*)
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City(*)
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State(*)
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Zip(*)
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Registration Submission (Select One)

NOTE: Each runner must complete a registration form (with waiver) for each entry, even if the runner is participating in multiple divisions.

Submit Type (Select One)
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