register - Peter De Mott Peace Trot

2022 PDPT registration

* Indicates required field

Name: *

First

Last

Address: *

Line 1

Line 2

City

State

Zip Code

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Email: *

I plan to participate in the: *

5k 1-Mile Fun Run I am not trotting BUT please send me a T-shirt

Age on June 19, 2022: *

Gender: *

Male Female Other

$ registration donation amount *

I will pay by: *

Check PayPal

T-Shirt Size *

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