5-State Run Registration

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Event: May 13th 2023
Event Address: 2626 Mile 26 RD Goodwell,Ok.
Contact us at (405)742-2881 or 5staterun@gmail.com

Rider *

Address *

City/State/Zip *

Phone number *

Email *

Signature *

Date *

Passenger

Address

City/State/Zip

Signature

Date

YYYY

Packets *

Registration Includes 1 hand,1 meal,1 patch,1 rocker & 1 pin $ 55.00

Additional Hand ............................................................................$10.00

Additional Meal..............................................................................$15.00

Required

Packets

Registration Includes 1 hand,1 meal,1 patch,1 rocker & 1 pin $ 55.00

Additional Hand ............................................................................$10.00

Additional Meal..............................................................................$15.00

I understand that I am participating in this event with the full knowledge there are implied risks of accidents and/or injury or destruction of property, and I assume responsibility for any aforementioned risks. I hold harmless any and all parties associated with this event from any liability whatsoever
*

I understand

Required

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