You must fill out the entire form. It will not be sent unless all fields are filled in.
Name A value is required.
Address A value is required.
City A value is required. State A value is required. Zip A value is required.
Phone A value is required.
Age on race day A value is required. Date of birth A value is required. Sex A value is required.
Clydesdale (male 190+) Filly (female 140+)
T-shirt size: A value is required.
Name on the credit card you will be paying with: A value is required.
In consideration of this entry being accepted, I hereby, for myself and my heirs, executors or administrators, waive and release all rights and claims for damages I may have against Murdick's Fudge of M.V., the Town of Tisbury and any and all sponsors for any and all injuries incurred before, during or after Murdick's 5 Mile Run the Chop Challenge.
Check box to signify that you agree to the above considerations. Please make a selection.