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National Corntoss Challenge Champion Application

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* 1. Full Name:

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* 2. Address:

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* 3. City, State, Zip:

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* 4. Phone Number:

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* 5. Email Address:

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* 6. I am...

An ALS patient.

A relative of an ALS patient.

A friend of an ALS patient.

A relative of a deceased ALS patient.

A friend of a deceased ALS patient.

A caregiver.

Other (please specify)

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* 7. Have you attended any Corntoss events?

Yes

No

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* 8. If you answered yes to the previous question, which Corntoss event did you attend and when?

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* 9. Have you ever been involved with other events involving ALS TDI?

Yes

No

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* 10. If you answered yes to the previous question, which ALS TDI event(s) have you attended, volunteered, or donated to?