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Stead Tread 5K Registration Form

DONATIONS ALSO POSSIBLE, AT THE BOTTOM OF THIS REGISTRATION FORM!

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Categories *

5K (Ages 13 or older and not a Lincoln patient) - $35.00

5K (Lincoln patient) - No charge

5K (Ages 12 or younger) - No charge

Participant Information

Contact Email *

Participant First Name *

Participant Last Name *

Participant Birthdate *

Participant Gender *

Identifies as Female

Identifies as Male

Non-Binary

Country *

Street Address (w/Apt#) *

City *

State *

Zip Code *

Phone *

Would you like to receive important event text alerts on this number (eg. changes or delays)?

Emergency Contact *

Emergency Phone *

Check the box if you do not want your name on the Participant List of our website.

Adult T-Shirt Size *

Shirt Sizes are guaranteed to all entered by September 1.

Check the category that best applies to you *

Duke Internal Medicine Resident

Lincoln Patient

Housestaff not in Duke Internal Medicine program

Duke Faculty/Staff

Duke Student

Duke Advanced Practice Provider (APP)

None of the above

Duke Department and Division (e.g., Medicine-Rheumatology):

School:

If you are a member of a team (e.g. corporate sponsor or otherwise), please list the name here:

Do you want official chip timing? *

Chip timing (you will receive an official time and be eligible for time-based awards)

No chip timing (no official time, not eligible for time-based awards)

Will this be your first Stead Tread?

Yes

Check here to opt-out of post-event communication from Stead Tread and its sponsors.

Make a Donation

Lincoln Community Health Center
click here, to learn more about this cause

Amount $

Join the Eugene Stead Honor Roll: We are launching an Honor Roll to recognize the generous faculty donors who help enable a high-quality event and support our residents' participation and the Lincoln clinic! All contributions of $100 or greater will be recognized on the Eugene Stead Honor Roll on our website and at the event. All donations are tax-deductible.

Waiver *

I have read and agreed to the TERMS *

CLICK HERE TO VIEW THE TERMS.

Is the participant 18 or older? *

18 or older Under 18

Payment Details

Discount or Tracking Code

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Price

Discount (-)

Donation

Total Owed

Payment Method

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