W2R Walk Registration

Walk 2 Remember Registration Form
Thank you for being a sponsor for the 2024 Walk 2 Remember & Car Show. The beneficiaries of this annual event are the families and caregivers who struggle daily with the many aspects of dementia. Your sponsorship of this event will provide exposure to you and your organization, and also help Our PLACE to continue providing "Moments of Joy" to so many individuals.

October 5th – Lenoir City Park – 9:30 A.M. to 12:00 P.M.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
E-mail*
Are you walking as an individual or part of a team?*

Walking as an individualWalking a part of a team (add team name below)
Team Name
Minimum Donation

$50 per person to walk (includes an event T-Shirt)

Children 12 and under are free (no T-Shirt included)

** This form must be submitted by XXX XX, 2024 **
*
Categories:All

All

Additional Donation
prevnext( X )
Walk Registration & T-Shirt (select size below in form)Walk and Event T-Shirt
$50.00

Additional Donation

Enter Desired Amount
$1.00 Amount
Item subtotal:$0.00

Total

$0.00
Select a T-Shirt Size*

SmallMediumLargeX-Large2X-Large3X-Large
NOTE: Before adding your payment type and submitting this form, please make sure you have checked the level at which you want to walk and indicated whether walking as an individual or part of a team. Also, make sure you have selected a T-Shirt size (if you chose the $100 "Walk & T-Shirt" option).

IMPORTANT: After submitting this form, you will see a Thank You page and at the bottom is a link to the Participation Release Waiver Form. You MUST fill out this online form and digitally sign it or you will not be able to participate in the Walk 2 Remember.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Walk 2 Remember Registration Form