Print Registration

  • print
    Please note price increase if registration is postmarked on or after 10/12/2019
  • Please list a person we can contact on your behalf if an emergency or urgent situation arises.
  • Please the phone number of your emergency contact person.
    Please disregard if registering after Oct 12, 2019. T-shirts will be available as first come - first serve at packet pick up.
    Please disregard if registering after Oct 12, 2019. T-shirts will be available as first come - first serve at packet pick up.
    Each sign is $10. Please include this cost with your registration amount. You will have the option of writing your message on the sign at packet pick up.
  • Print and mail with your check to:

    Theresa Tracy Strive To Survive
    PO Box 2464
    East Peoria, IL 61611

    Make checks payable to “Theresa Tracy Strive to Survive”
    For Questions Contact Orin Naramore: 309-261-2157

    In Consideration of the acceptance of my entry, I for myself executor, administrator, and
    assignees do hereby release and discharge Theresa Tracy Strive To Survive, City of East Peoria,
    and all other sponsers from all claims or damages,

  • Signature (Parent Signature if under 18 yrs old.)


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  • Date Format: MM slash DD slash YYYY