2017 Moonlight Run On-Line entry

Please fill in the requested information below. When complete press the preview button and preview/verify the information on the next screen. If the information is correct press the "Pay Here" button and you will be redirected to the Paypal processing site where you MUST select a payment method and provide any information they require. Once successfully paid you will be directed back to the Moonlight Run page. NOTE: If Payment is Successful you will receive payment confirmation email (within 24hrs) both from Paypal and an entry confirmation from us . If you do not receive our email within 24hrs PLEASE check your SPAM folder. If you still do not find the confirmation email OR if you are having trouble with this entry form please contact us at ranmorz@telusplanet.net.) IF you DO NOT RECEIVE PAYPAL CONFIRMATION YOU ARE NOT ENTERED!! Please check your SPAM folders for email confirmations.

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FEES :
EARLY
: BEFORE Midnight March 6/2017
ADULT 16 and Over:
- $42.50 with HOODIE (includes $2.50 processing fee) + $3 for XXL Size
- $27.00 NO HOODIE (includes $2.00 processing fee)

YOUTH 15 and Under:
- $21.50 with Youth Sized Long Sleeved TShirt (includes $1.50 processing fee) OR
- $26.50 with Adult Sized SweatShirt (includes $1.50 processing fee) + $3 for XXL Size
- $11.00 NO Sweat Shirt (includes $1.00 processing fee)

LATE: AFTER Midnight March 6/2017
Adults: $27.00 NO SHIRT ( includes $2.00 processing fee)
Youth: $11.00 NO Sweat Shirt (includes $1.00 processing fee)
ALL Entries include 1 slice of pizza, Tim Hortons treat and refreshment.
Additional Pizza Tickets available at $2/ea

NOTE- ALL Entries are NON-REFUNDABLE ,
BUT are TRANSFERABLE UPON REQUEST
Visa, M/C, Paypal ** ALL Payments are handled securely by
Paypal ** DATA GRAPHX
and will appear on your Credit Card OR /Paypal statement as such
.
A PayPal Account is NOT Required

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(E-mail)

AS OF RACE DAY MARCH 18/2017

(Date mm/dd/yyyy) mm/dd/yyyy format please

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