EmailMe Form - 2016 =PR= Race Team Application

Name: *
First Last
Email: *
Birthdate: *
Preferred =PR= store (please note, this is your HOME store and all gear will be delivered there for pick up):
Are you a current =PR= Race Team member?
Yes
No
Personal Record 5k (Must be in last 2 years. List race, date, and official time):
Personal Record 10k (Must be in last 2 years. List race, date, and official time):
Personal Record Marathon (Must be last 2 years. List race, date, and official time):
Personal Record Triathlon (Must be in last 2 years. List race, date, and official time):
Personal Record OTHER (Must be in last 2 years. List race, date, and official time):
2016 running goals and planned races:
Why do you want to be a member of the =PR= Race Team?
Facebook page/url:
Twitter handle:
Instagram handle:
Blog url:
Other: