Walk for Hope 2013
Registration Form

Please enter the walker name and contact information, choose the appropriate T-Shirt size, bring your signed waiver, which is printed on the flyer, to the registration table the day of the walk.

*Note: The entry fee for each walker is due upon registration. YOU MUST REGISTER, THEN PAY TO BE REGISTERED FOR THE WALK AND RECEIVE YOUR T-SHIRT.
**Please register only one person at a time.

Name:

Street Address:

City:

State: Zip:

Phone:

Email address:

Would you like to be added to our email/mailing list?
Yes No

Your Age Level:
6 and under: FREE
7-12: ($5.00 entry fee)
13-17: ($10.00 entry fee)
18 & over: ($25.00 entry fee)

1) Your entry fee: $
Choose Your T-Shirt Size:
Adult sizes only: S M L XL XXL

Additional T-Shirts:
Please mark total number of each size requested and add $15 for each extra shirt:

Adult: S

Adult: M

Adult: L

Adult: XL

Adult: XXL
2) Total number of extra shirts

X $15.00 = $

3) Unable to participate, but would still like to

make a donation? $

4) Amount of additional donations collected: $

Total Submitted (Add 1-4) $

Register Now. Next step will be to send your payment through PayPal. Remember, you must send your payment to be assured of receiving a T-shirt.

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Walk for Hope 2013 Registration Form

Walk for Hope 2013
Registration Form