Benton’s 5K / Fun Walk T-Bird Trot has been fun event for our community. Help us make it even more rad, register below.5K Registration Fields marked with an * are required$30.00 - Adult Registration$20.00 Youth Registration (12th Grade and under)Instructions:1. Register the first participant. 2. Register up to 5 additional participants. 3. Check out once, via secure PayPal servers.ALL information must be filled out completely and waiver must be signed. Select Participant Type * Adult 5K $35 Adult Fun Walk $35 Youth 5K $20 Youth Fun Walk $20Personal Information First Name * Last Name * Email * Used for Registration Confirmation Gender * Female Male Date of Birth * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * T-Shirt Size * Adult-Small Adult-Medium Adult-Large Adult-X Large Adult-XX Large Youth-Small Youth-Medium Youth-Large Do you want to add a second participant? * Yes NoSecond Participant Select Participant Type * Adult 5K $35 Adult Fun Walk $35 Youth 5K $20 Youth Fun Walk $20 First Name * Last Name * Gender * Female Male Date of Birth * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming New Option Zip Code * T-Shirt Size * Adult-Small Adult-Medium Adult-Large Adult-X Large Adult-XX Large Youth-Small Youth-Medium Youth-Large Do you want to add a third participant? * Yes NoThird Participant Select Participant Type * Adult 5K $35 Adult Fun Walk $35 Youth 5K $20 Youth Fun Walk $20 First Name * Last Name * Gender * Female Male Date of Birth * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * T-Shirt Size * Adult-Small Adult-Medium Adult-Large Adult-X Large Adult-XX Large Youth-Small Youth-Medium Youth-Large Do you want to add a fourth participant? * Yes NoFourth Participant Select Participant Type * Adult 5K $35 Adult Fun Walk $35 Youth 5K $20 Youth Fun Walk $20 First Name * Last Name * Gender * Female Male Date of Birth * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * T-Shirt Size * Adult-Small Adult-Medium Adult-Large Adult-X Large Adult-XX Large Youth-Small Youth-Medium Youth-Large Do you want to add a fifth participant? * Yes NoFifth Participant Select Participant Type * Adult 5K $35 Adult Fun Walk $35 Youth 5K $20 Youth Fun Walk $20 First Name * Last Name * Gender * Female Male Date of Birth * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * T-Shirt Size * Adult-Small Adult-Medium Adult-Large Adult-X Large Adult-XX Large Youth-Small Youth-Medium Youth-Large Disclaimer and ReleaseParent must sign if the participant is under 18 years of age. In consideration of this entry being accepted, I hereby for myself, heirs, executors, administrators, and any minor child (if applicable), waive and release any and all rights and claims for damages that I have against all sponsors, and persons employed, representative, successors, or otherwise connected with this event in any way and assigns for any and all injuries suffered by me in said event including travel to and from this event. I verify that I am physically fit and have sufficiently trained for the completion of this event. I Have read and agree to the Disclaimer and Release * YesTo complete this purchase, we utilize PayPal’s encrypted, secure servers. A PayPal account is not required.You can choose to pay with a credit card or a PayPal account. After the payment is processed, you can view your order details and we will email you a receipt.Thank you for supporting 2019 5K T-Bird Trot! Total Review Total Review Total Review Total Review Total Review Total payment due today for registration. Email If you are human, leave this field blank. Submit
