K&W Engineers - TecPort 5K Run/Walk

K&W TecPort 5K Run/Walk Registration Form

Credit Card Payment complete info below
Check Payment click on registration form, print, complete and return with check payable to:
Gaudenzia Inc.
c/o K&W Engineers and Consultants
470 Friendship Road, Suite 100
Harrisburg, PA 17111

Please complete the form below to register for the K&W TecPort 5K Run/Walk. You may also register any participating family members. After you submit the required information, you will be sent an email with instructions on how to complete your registration.

Individual Registration:

Name First Name MI Last Name

Address

City/State/Zip

Phone

Gender Male Female

Age

Activity Run Walk

T-Shirt Size

Participating Family Members:

You may register one child ($40.00) or up to 3 family members ($60.00). Please fill out the fields below and click "Add" to add another family member. If you are just registering yourself, please skip this section.

Name First Name MI Last Name

Gender Male Female

Age

Activity Run Walk

T-Shirt Size

Emergency Contact

Emergency Contact Phone

I agree to terms

Payment Options

Individual
$25.00

Parent & Child
$40.00

Family (up to four)
$60.00

Additional Donation or Non Participant Donation - Enter Amount:

Total Donation:

Credit Card: Master Card Visa

Card Number:

Name on Card:

Expiration Date:

Thank you for your registration and/or donation. All proceeds will be distributed to Gaudenzia, Inc. and The Woodside Family Center.

Emergency Contact:

In the case of emergency during the event, who can we contact?

Name

Phone

I agree to terms

K&W Engineers and Consultants

K&W TecPort 5K Run/Walk Registration Form