2015 Checkers AC Membership Application

WHICH RACE/EVENT? DATE DISTANCE CAPACITY ENTRY FEE
Full Time Student Jan 31, 2016 1 year -- $25.00
Individual Jan 31, 2016 1 year -- $35.00
Individual Jan 31, 2017 2 years -- $60.00
Individual Jan 31, 2018 3 years -- $85.00
Married Couple/Domestic Partnership Jan 31, 2016 1 year -- $45.00
Married Couple/Domestic Partnership Jan 31, 2017 2 years -- $80.00
Married Couple/Domestic Partnership Jan 31, 2018 3 years -- $115.00
Family Jan 31, 2016 1 year -- $50.00
Family Jan 31, 2017 2 years -- $90.00
Family Jan 31, 2018 3 years -- $130.00

Instructions

This process includes three short sections:
1) personal information and waivers
2) additional questions and extras
3) payment.

Your registration is not complete until you have finished all three sections and see a confirmation page.

***NOTE***
Your credit card statement will reflect a charge from Score This!!!, Inc. Event Registrations, the provider of online registration services for this event. ***
 

Waiver

Agreeing to the waivers and payment of entry fee constitutes your acceptance of organizer's policies.

If you are younger than 18, a parent or guardian must electronically sign your online entry.
 

Payment

***NOTE***
Your credit card statement will reflect a charge from:
Score This!!!, Inc. Event Registrations
the provider of online registration services for this event.
Online Payment Service
 
First name
Last name
Gender
Street address

City
State/Province
Zip
Email
Phone
Birthdate
Country
 
Waiver
 I agree       Initials of athlete over 18 years of age or parent/legal guardian of minor under 18 years of age or legal guardian of incapacitated and/or mentally challenged person: 
 
Registration is closed for this event.