Participant Registration

Participant First Name:*

Participant Last Name:*

Participant Email:*

Confirm Email:*

By registering as a participant and providing your email address, you are agreeing to receive important participant event updates via email.

User Name:*

A user name and password must be entered in order to be able to access and update your personal fundraising page.
Enter a unique user name for each participant of the event. No spaces allowed.
(i.e. first and last name: janedoe or first initial and last name jdoe)

Password:*

Minimum 6 characters. At least one letter and one number.
Only enter letters, numbers, periods, hyphens or exclamation marks.

Confirm Password:*

I would like to set a goal of:*

In addition to registering, I would like to make a donation in the amount of:

$.00

Shirt Size:*

Small
Medium
Large
X - Large

Birth Date:*

(mm/dd/yyyy)

Gender:*

Male
Female

Waiver and Release
In consideration of this entry being accepted, I hereby for myself, heirs, executors, and administrators, waive and release any claim I may have against the Cameri, the Boroughs, the State, its officers and directors, the organizing committee, the sponsoring organizations, the county or their representatives, successors, or assignees for any injury that may be suffered by me at or in this event.

Release:*

I have carefully read this Waiver and fully understand its contents. I am aware that by accepting this Waiver, I am waiving legal rights and knowing this, I accept it of my own free will.