Print Registration

    Register by October 15, 2017 to guarantee receiving a T-shirt*
  • 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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