Fall 2019- RM Registration
Welcome to our Fall 2019 season!

Please fill out a registration form for each Running Medicine participant.

The cost for each participant is $15.00 and includes a Running Medicine shirt. RM accepts cash or checks (Checks payable to NHI-Running Medicine).

Please complete registration for every RM participant
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Ethnicity/ Tribes *
Your answer
Phone Number *
Your answer
Email *
Your answer
Shirt Size *
XS
S
M
L
XL
2XL
Size
Tell us your story! How did you hear about Running Medicine - Acoma/ Laguna?
Your answer
What are you goals? Give us 1-2 goals for the season:
Your answer
Emergency Contact Info (First & Last Name/Relationship/Phone Number): *
Your answer
Do you have any existing medical conditions? *
Required
If "Yes", list condition(s)
Your answer
List current medications (such as Albuterol for asthma):
Your answer
Signature of Participant (Parent Signature if under 18) *
Your answer
Name of Participant *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service