Rock The Race - Registration Form

Rock The Race - Team Registration

Registration Fees:

4 Hour/ 2 Person Team: $150
4 Hour/ 3 Person Team: $225
4 Hour/ 4 Person Team: $300
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8 Hour/ 2 Person Team: $198
8 Hour/ 3 Person Team: $297
8 Hour/ 4 Person Team: $396

Registration is now open for the 2010 race. Feel free to come out and Rock the Race!

Please note: The YMCA will occasionally assign a photographer to take pictures of various activities.

These photos may be used in YMCA marketing materials. If you do not wish to be photographed, please step away from the camera or notify the photographer.

There are two parts to the registration process -

This form lets you tell us about yourself and your teammates. When this form is completed and submitted, a confirmation page will be returned with a a link to the second form.

The second form will allow you to pay your registration fee via a credit card. If you have any difficulties registering or paying on line, please contact Mel at 815-489-1289.

Please provide the following contact information:

        Team Name

   Captain's Name 

   Street Address 

             City 

            State 

              Zip 

       Home Phone 

       Work Phone 

              FAX 

           E-mail 

              Age 

    DOB: mm/dd/yy 

             Sex:  male  female

     T-shirt size

Teammate 2's Name 

   Street Address 

             City 

            State 

              Zip 

       Home Phone 

       Work Phone 

              FAX 

           E-mail 

              Age 

    DOB: mm/dd/yy 

             Sex:  male  female

     T-shirt size

Teammate 3's Name 

   Street Address 

             City 

            State 

              Zip 

       Home Phone 

       Work Phone 

              FAX 

           E-mail 

              Age 

    DOB: mm/dd/yy 

             Sex:  male  female

     T-shirt size

Teammate 4's Name 

   Street Address 

             City 

            State 

              Zip 

       Home Phone 

       Work Phone 

              FAX 

           E-mail 

              Age 

    DOB: mm/dd/yy 

             Sex:  male  female

     T-shirt size