Jiggly Piggly Registration Form First Name*Last Name*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Age*Under 21Over 21 (ID will be required at check-in)Contact Numbr*Emergency Contact Name* First Last Emergency Contact Contact Phone*Email* T-Shirt Size*SmallMediumLargeX-LargeXX-LargeXXX-LargeWavier* I Agree I acknowledge that my participation in the Jiggly Piggly Food Run involves a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge Uptown Lexington Inc. and their respective directors, officers, employees, affiliates, members, agents, and representatives, of and from any and all liability, losses or damages, incurred by me in connection with any aspect of the food run. Registration Fee* Price: $50.00 Total $0.00 PhoneThis field is for validation purposes and should be left unchanged.