Lupus Awareness Memorial Walk Registration - May 18, 2025
Time 9:00am - 1:00pm
Central Park 6540 State Route 31 Cicero NY 13039
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre Registration
Per Person - $25
Team of 5 - $100 Please list names of the 5 individuals on team in box below
Registration - Day Of
Per Person - $30
Names of Walkers on this registration
Preorder Adult Shirt - $20 each -
Small - enter number
Medium - enter number
Large - enter number
XLarge - enter number
2XL - enter number
Payment Made By
Zelle - 315-256-4938
CashApp - $Lupus2024
Venmo - @Lupus-2024
Enter payment Amount_________________________
Submit
Should be Empty: