Please Join Us at the 2nd Annual 5K Walk to Stomp Out Child Abuse
REGISTRATION FORM (Please complete all fields.)
Name
Address
City
State Zip
State ZipPhone # E-mail
E-mail What is your team's name, if you have one?
Team Members (include T-shirt size, indicate Adult or Child)
NAME & AGE IF UNDER 13 T-SHIRT SIZE
T-SHIRT SIZENAME & AGE IF UNDER 13 T-SHIRT SIZE
T-SHIRT SIZENAME & AGE IF UNDER 13 T-SHIRT SIZE
T-SHIRT SIZENAME & AGE IF UNDER 13 T-SHIRT SIZE
T-SHIRT SIZEREGISTRATION FEE DUE FOR ALL TEAM MEMBERS (Mastercard, Discover, Visa, or Check) $25 per person, but only $15 for those under 13 yrs. old
TO PAY BY CREDIT CARD (Be sure address above is billing address.)
NAME AS IT APPEARS ON CARD
CREDIT CARD TYPE
CARD #
EXPIRATION MONTH & YEAR
3 DIGIT CODE ON BACK OF CARD
TO PAY BY CHECK
Please download the Registration Form, and mail it
along with your check to the address on the form.
Date:Saturday, March 24
Saturday, March 24Schedule:7:00 am Registration
7:00 am Registration8:00 am Walk Commences9:30 am Awards & ClosingLocation:Inside Memorial City Mall (I-10 and Gessner)
Inside Memorial City Mall (I-10 and Gessner)Fee:$25.00 per person ($15 for participants under 13 yrs.)
$25.00 per person ($15 for participants under 13 yrs.)Prizes: Including a $250 mall gift certificate, you must be present to win
Including a $250 mall gift certificate, you must be present to win