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Online Registration is now CLOSED

NAME
BAR NO.
FIRM
ADDRESS
CITY
STATE & ZIP
PHONE
BIRTH DATE
E-MAIL
RECRUITING ORGANIZATION
(must be filled in for team recruiters'
competition credit)

SPEED COMPETITION TEAM
(team name)
SHIRT SIZE
BABY SHIRT SIZE
(baby stroller participants only)
DIVISION SELECTION
(select only one division per registrant)
DIVISION GENDER
14 & Under Male Female
15 - 17 Male Female
18-24 Male Female
25-29 Male Female
30-34 Male Female
35-39 Male Female
40-44 Male Female
45-49 Male Female
50-54 Male Female
55-59 Male Female
60-64 Male Female
65-69 Male Female
70-74 Male Female
75 & Over Male Female
Wheelchair Male Female
Baby Stroller Male Female
Chaise Lounge  
In Absentia  
PAYMENT
PRE-REGISTRATION
(before 5/2/12 after $35.00)
BABY STROLLER
(add to regular registration fee)
CHARITABLE DONATION TO
"AND JUSTICE FOR ALL"
$
TOTAL PAYMENT $
PAYMENT METHOD

American Express Visa MasterCard

NAME ON CARD
CARD NO.
Personal Corporate
EXP.
BILLING ADDRESS
ZIP
RACE WAIVER AND RELEASE