Arkansas FCA - Registration

Arkansas FCA

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River Valley Run Registration
Step 1: Enter Your Information
Please fill out the form below and enter the total amount due at the bottom of the form. After submitting this form, you will be brought to Step 2 where you will submit a release form and then Step 3 where you will enter in your amount due and pay by credit card.

First Name*
Last Name*
Street Address or PO Box*
City*
State*
Zip Code*
Daytime phone*

Age as of 9-27-2008*
Birthdate (mm/dd/yyyy)*
email address*

Gender*
Choose Your Race*
Official T-shirt Size*
Optional Fees
Pasta Dinner
Additional t-shirts
Donation to FCA (tax deductible)
Donation to "Heal Africa Mission" (tax deductible)

IMPORTANT Please calculate your total fees/donations and enter below. You will use this total and enter it again on the following page to pay by credit card.

Total Fees*
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* indicates a required field

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