Distance Running Camp Registration Form

* = required field

First Name*
Last Name*
Grade next fall*
School*
Gender*
Age*
Birth date (MM/DD/YYYY)*
Home address*
City*
State*
Zip Code*
Home phone
Parent's cell phone
Camper's cell phone
Camper's e-mail
Parent's e-mail*
Preferred roommate (one name only)
Adult T-shirt size*
Refund Policy: Written or e-mailed cancellation notice that is received five or more business days prior to the first day of camp will result in a full refund, less a $50 cancellation fee.
Attending as*
Payment Amount*

Payment Method

Name as it appears on card*
Credit Card Number*
Credit Card Type*
Expiration mm/yyyy*
Security Code*