Komen for the Cure - Des Moines Affiliate

Please complete the form below.
Required fields are indicated with an *

Race Participant Information - The name below MUST be the name of the person who will be registering for the selected race event. You may add as many registrants as you like and pay for all of them during the checkout process. You will also be given the chance to save the "registration cart" and return later to complete the payment process.

*Team Selection	If you are registering as part of a team you MUST select the team from the list, otherwise this will be considered an individual entry. Note: A team selection may have been made automatically based on your first selection of if you are accessing from an email invitation link.
*Race Event/Fees
Timed Race:	I would like to be electronically timed (Additional $2.00).
*First Name:
*Last Name:
E-mail:	(This email is for THIS registrant, if unknown please leave blank)
*Phone:	Formatted (515)555-5555 or 555-5555
*Address 1:
Address 2:
*City:	State/Province: Zip:
*Country:
*Gender
*Age:	(Note: The Kid's Race is for children 10 years old and under)
*T-shirt size
Survivor:	I would like to be recognized as a breast cancer patient or survivor by receiving a complementary pink cap.
Mailing List Sign-up:	Add this person to the Des Moines Race for the Cure Mailing List.
Volunteer Opportunity:	This person would like to be notified of volunteer opportunities with Komen Des Moines.