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Northwest Missouri State University


5K Walk/Run Request Form

All fields required.

Hosting Information

Organization Name:

Contact Information (the person primarily responsible for the event)

Name:
Email
Phone Number:

Event Information

Date: (format: MM/DD/YYYY)
Time: (include a.m. or p.m.)
Description:

Your organization must be able to provide a certificate of insurance for $1million listing Northwest Missouri State University as an additional insured before you will be allowed to schedule.