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National Corntoss Challenge Champion Application
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1.
Full Name:
(Required.)
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2.
Address:
(Required.)
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3.
City, State, Zip:
(Required.)
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4.
Phone Number:
(Required.)
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5.
Email Address:
(Required.)
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6.
I am...
(Required.)
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?
(Required.)
Yes
No
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?
(Required.)
Yes
No
10.
If you answered yes to the previous question, which ALS TDI event(s) have you attended, volunteered, or donated to?
