Dirty Kiln Race Entry Donation Form

Many organizations are in our region are greatly impacted from fulfilling their missions. You have the option to request a refund your entry fees and have them donated to one of these three organizations in our region:

  • AMED
  • Central PA Humane Society
  • St. Paul Food Pantry

Please fill out the form below and we will make sure your entry fees will go to your designated non‑profit.

Please enter your name and your email that you used for your Ultrasignup account.. In the message, please let us know the organization you like your fee to go to and any other information or messages you want to relay.

Donation Form

Fields marked with * are required.

Name

Managed By Cassus Media