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Captain Request - Bronson Children's Hospital 5K
September 29, 2019
Note: This event requires entry of a comp code for Captains
The Captain comp code for this event is 5138. Use this code when registering at the host event sign-up page to ensure fully comped registration. The Bronson Children's Hospital 5K race administrator will verify offered comp codes against a myTEAM TRIUMPH participant list.
Current Captain Application? *
I have filled out the Captain Application on the Michigan Chapter website at: https://www.myteamtriumph-mi.org/become-a-captain
Last Name *
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First Name *
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Street Address *
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City *
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State *
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Zip *
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Phone *
xxx-yyy-zzzz
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Email *
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Emergency Contact Name *
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Emergency Contact Phone *
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Birthdate *
MM
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DD
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YYYY
Shirt Size *
mm/dd/yyyy
Teammate Request
If you would like to team with specific Angels for this event, please share their names here (while we cannot guarantee teaming arrangements, we will do our best to honor your request):
Your answer
Event Waiver *
I plan on walking or running in Bronson Children’s Hospital Walk & Run. I am physically able to participate in this event. No person or company is responsible if I am injured during this event. I will not hold Bronson Healthcare Group, the County of Kalamazoo or the City of Kalamazoo responsible if I am injured. You may use my name and any pictures of me in any news about the event. This includes print, video and online. All the information I have provided about myself in this waiver is true..
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