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REGISTER for the Village Manor "Steps for Support" Relay Walk

1.Name (first and last)(Required.)
2.Email(Required.)
3.Phone Number(Required.)
4.Please check appropriate designation.(Required.)
5.How many laps will you pledge? (Most residents will probably complete one lap only with you, and you will finish the laps pledged for entry into prize drawing).(Required.)
T-shirt purchase is OPTIONAL. Please note there is a $2 dollar price increase for XLarge sizes. T-shirts and event fees will be collected at check-in on the day of event. MHS employees may use payroll deduct for t-shirt purchases at the Caring Hearts Gift Shop.
6.OPTIONAL t-shirt for $20.00 ($2 extra for XL sizes).