Paper Registration Form

5th Annual Stomp out Sepsis


Race Location
Lilburn City Park
76 Main Street NW
Lilburn, Georgia
Print Form - Bring To Race
Check, Credit Card, Cash,
Venmo, and Apple Pay are
accepted at race check-in.
___________________________________
First Name		 _________________________________
Last Name
Gender:   Male     Female     Age (on 9/26/2026): ______
  First 4 Participants $92.00.
Registration:
5K $33.00  
Fun Run $18.00  
Virtual 5K $30.00  
Select an event to register for.
T-Shirt Size:
Youth SM (SOLD OUT)  
Youth MED (SOLD OUT)  
Youth LG (SOLD OUT)  
SM  
MED  
LG  
XL  
2XL (SOLD OUT) add $2.00  
No T-shirt (I waited too late and my size isn't available)   
Select what size shirt .
Are you a SCCM SE Chapter Member?: ______________________________
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  • Reviewed and understand FundRacers' "Privacy Policy"
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Signature: __________________________________________  Date: ___________