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Walk Registration
Walk Registration
Please fill out the form below to register for the April 15th, 2018 Walk. Upon submitting this form you will be directed to Paypal where you can complete your payment.
Please choose one of the following
Yes, I am walking. Minimum $20 donation per walker required.
No, I can't attend but wish to make a donation
Number of Walkers
Name of Walkers
T-shirt Sizes (Adult S, M, L, XL, XXL / Youth S, M, L, XL)
Team Name
Donor Information
Name
*
First
Last
Company / Firm
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Phone
Donation for Walk
*
$20 minimum fee per walker