15th Annual Run Wild for Autism 5K & 1 Mile Fun Run & Walk Online Registration

Registrant #1

Who are you registering? *

First Name *

Last Name *

Email Address *

Confirm Email *

Create Password *

This will be the password for your RunSignup account.

Confirm Password *

Date of Birth *

Used for age group calculations

Gender *

Male Female

Phone *

Valid formats include: 000-000-0000 or 0000000000

Street Address *

Country *

Zip Code *

City *

State *

$48.70 incl. $3.70 Fee

($0: Ages 0 - 10)

($27.50: incl. $2.50 Fee Ages 11 - 17)

(Group Pricing)

1 Mile Fun Run & Walk

$48.70 incl. $3.70 Fee

($0: Ages 0 - 10)

($27.50: incl. $2.50 Fee Ages 11 - 17)

(Group Pricing)

Ages	Price
10 and under	$0.00
11 - 17	$27.50 incl. $2.50 Fee

Ages	Price
10 and under	$0.00
11 - 17	$27.50 incl. $2.50 Fee