Register for the Kids Dash We’ll have some fun for kids 10 and under as well on the day of the race. You can sign up here. "*" indicates required fields Step 1 of 2 50% Registration Information*One credit card transaction per registrant.Registration Type* Individual Walker ($25) Individual Runner ($25) Kids Dash ($10) Additional Gift I wish to make an additional contribution Additional Gift Amount* HiddenFrequency – Monthly Make this a monthly donation HiddenFrequency – Annual Make this an annual donation Total Donation Amount HiddenDesignation Your InformationCredit Card Details* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name TitlePlease SelectDr.Mr.Mrs.Ms.Mx.Name* First Last Email* Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Participant InformationName* First Last Email Gender*Please SelectMaleFemalePrefer not to answerHiddenT-Shirt Size*Please SelectExtra LargeLargeMediumSmallYouth MediumOnesieBirthdate* Month Day Year Age on Race Day*I understand that walkers may NOT run the course and will be disqualified. In consideration of this entry being accepted, I hereby, for myself and my heirs, executors or administrators, waive and release all rights and claims for damages I may have against MVH, the Town of Oak Bluffs and all sponsors for any and all injuries incurred before, during or after this race. Further, I hereby grant full permission to any and all of the foregoing to use my likeness in all media including photographs, pictures, recordings or any other record of this event for any legitimate purpose.I agree with the above statement* I agree Electronic Signature* First Last Today's Date* Month Day Year Additional DetailsCorporate This is a donation from a corporation Company Name* CommentsHiddenAdminHiddenAtlas Fund HiddenAtlas Appeal HiddenAtlas Event ID HiddenPage InfoHiddenReferer HiddenEmbed URL HiddenPage Title HiddenForm ControllersHiddenRecurring Controller HiddenTribute Controller HiddenAnonymous Controller HiddenCorporate Controller HiddenDesignation Controller HiddenAuthorize.netHiddenAuthorize.net Transaction Details HiddenAuthorize.net Response Code EmailThis field is for validation purposes and should be left unchanged.
