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Event: Surf the Murph 25K
Contact Information
* = required field
* Your name will appear just as it is entered on name badges and certificates.
* First Name:
* Last Name:
* Region
* District/Agency:
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* School/Building:
 
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* Job Title:
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* Telephone:
* Fax:
* Email(x@y.z):
* Confirm Email:
* Address:
* City:
* State:
* Zip:
Event Fees
*Fee(s): # Participants:
 
1        [$40.00] Event Fee
[$0.00] Enter "1" to indicate your signature of approval for the waiver
[$0.00] Enter Age on Race Day
[$0.00] Gender (Enter 1 for Female or 2 for Male)
[$0.00] Tshirt (Large Adult)
[$0.00] Tshirt (Medium Adult)
[$0.00] Tshirt (Small Adult)
[$0.00] Tshirt (XL Adult)
Billing Information
* Same as above:
* Bill to:
* Address:
* City:
* State:
* Zip:
* Payment Method:
 
I will send a check ()
Credit Card/EFT/E-Check - PaySchool