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1.
Name:
(Required.)
*
2.
Email:
(Required.)
*
3.
Address
(Required.)
*
4.
Phone Number
(Required.)
*
5.
Age:
(Required.)
*
6.
How did you learn about the Walk for Life?
(Required.)
7.
Do you attend a church? If so, which church?
*
8.
What distance would you prefer to walk
(Required.)
2-3 miles
3-4 miles
Other (please specify)
*
9.
What is your fundraising goal?
(Required.)
10.
Walking Team Assignment
(if you are creating your own team it must be at least 5 people and less than 10)
I would like Alpha Pregnancy Center to put me on a team
I have already created a team to walk with
My team members are:
*
11.
Do you have any health conditions of which we should be aware?
(Required.)
12.
Would you like to buy a T-Shirt for $20?
(People who raise more than $200 in support win a free t-shirt.)
Yes
No
If yes, what size?
13.
Would you like to help with the walk?
Yes, I'll be a team leader.
Yes, I'd help package gifts.
Yes, I'd help with registration or set up the day of the event.
Yes, I'd help with the clean up after the walk.
No, I'll enjoy just walking this year.
I have a different idea for helping out. Here it is:
Thanks for registering! Please follow this link
(https://www.egivingsystems.org/16394)
to pay your registration fee. Then, head back to our website to download your sponsorship form.
See you on October 19th!
