::2004 Moonlight Run Entry Confirmation ::
THANKS
[r_fname]
For Submitting Your Entry To The Runner's Soul
2004 Moonlight Run
You are entered in the [r_distance][r_gender][r_category] Category
You will receive email confirmation shortly
See you March 13/2004
(if you don't receive email confirmation within a 24 hour period please email us at ranmorz@telusplanet.net)
WE SUGGEST YOU PRINT THIS PAGE & RETAIN AS RECORD OF ENTRY
Print This Page

Ref Number: [unique_reference_number]

 

Name :

[r_fname] [r_lname]

 

Address :

[r_address], [r_city], [r_prov], [r_postal]

 

Contact eMail :

[re_email]

 

Phone No.:

[r_phone]

 

Race Distance/Category:

[r_distance][r_gender][r_category]

 

Shirt Size:

[r_shirtsize]

 

Refreshment Ticket:

[r_refreshment]

 

Entry Fee:

$[rd_entryfee]

 

Extra Pizza:

[d_extrapizza]x$2.00=$[]

 

Extra Liquor:

[d_extrabeer]x$2.50=$[]

 

Agreement: 

 [r_agree]

 

Total Amount:

$[]
this amount will be charged to CC# xxxxxxxxxxxx[r_visa4]

 

 

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