Walk for Wellness Sponsorship Registration
Please provide the below information and we will contact you confirming the details of your sponsorship.
Name
*
First Name
Last Name
Company Name
*
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Website Address
T-Shirt Size
*
Please Select
Small
Medium
Large
X-Large
XX-Large
I will pay by:
*
Check, and mail to Georgia Wellness, P.O. Box 685, Lawrenceville, GA 30046
Credit Card
Please Invoice me
Please send me GA Wellness W-9
Other
Sponsorship Level
*
Please Select
$10,000 - Presenting Sponsor
$5,000 - Weather Sponsor
$2,500 - Quarter Mile Marker Sponsor
$1,000 - Power Walk Sponsor
$750 - Pace Sponsor
$500 - Stride Sponsor
$250 - Step Sponsor
Amount to be paid by Credit Card (leave blank if paying by check)
prev
next
( X )
USD
Description
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please upload your company's vector quality logo here.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: