Health Information Technology Program 5K Run Registration Form

If you register online on the day of the race, you still need to head to the Registration / Check-in area to pick up your bib number and sign your waiver.

Contact Information

First Name:   Last Name:
Phone:  
Email Address:
Age:  Sex:   Shirt Size:

Payment










Billing Information

Logos: VISA, MasterCard, American Express, Discover
Credit Card Number:
Expiration Date:  

Billing First Name:  Billing Last Name:
Billing Address:
Street:   City:
State:   ZIP Code:


Credit Card Processing