Charity Walk/Run Online Registration
Sponsors
Please list the sponsors you have recruited along with their pledge amount below:
Sponsor 1 & Pledge Amount:*  
 
Sponsor 2 & Pledge Amount:  
 
Sponsor 3 & Pledge Amount:  
 
Sponsor 4 & Pledge Amount:  
 
Sponsor 5 & Pledge Amount:  
 
Sponsor 6 & Pledge Amount:  
 
Sponsor 7 & Pledge Amount:  
 
Sponsor 8 & Pledge Amount:  
 
Sponsor 9 & Pledge Amount:  
 
Sponsor 10 & Pledge Amount:  
 
Grand Total:  
 
Personal Information
E-Mail:*   Valid e-mail is required
First Name:*  
Last Name:*  
Address Line 1:*  
Address Line 2:  
City:*  
State:*  
Zip Code:*  
Marital Status:  
Gender:  
Date of Birth:  
Phone:*  
Credit/Debit Card Information
Card Number:*   No dashes or spaces please
Expiration Month:*   From your card
Expiration Year:*   From your card
Card Brand:*  

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