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
$15,000 - Presenting Sponsor
$10,000 - Weather Sponsor
$5,000 - Quarter Mile Marker Sponsor
$2,500 - Power Walk Sponsor
$1,000 - 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
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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: