Friends for Life - 2024 Registration Form

21st ANNUAL FRIENDS FOR LIFE BREAST CANCER AWARENESS WALK

Participant Registration Form
Date: October 12, 2024

Location: Yates Center Town Square

Time: Auctions start at 9:00am followed by the walk

**Follow our Friends for Life page on Facebook for updates.**

If you have any questions, please give Jamie Matile a call at 620-625-2125.

Thank you,

Friends for Life Team:

Jamie Matile, Abbie Collins, Holly Day, Jennifer Day, Amy McConaghie, Dina Morrison, Jeanie Shaffer, Beth Stockebrand, Carol Stuber, Brooke Tidd, Leah Wiehn

“When one neighbor helps another, we strengthen our communities.”
Participant Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Email*
example@example.com
Do you wish to receive your registration form via email next year?

YesNo

Adult registration is $20.00 and includes a t-shirt that is paid for by our business sponsors. Registration for children participating with an adult is $10.00 each and also includes a t-shirt.

We have crew and hooded sweatshirts available as an add-on below.

Please note: sweatshirts cannot be substituted for the t-shirt

2024 shirts are Heather Red

Please make your selections below for each participant:*

Adults

Adult Registration & T-Shirt (Required)Each registered adult will receive one t-shirt. Please indicate the quantity of registrations by each size of shirt.

$20.00

Size	Quantity	Price
S		$20.00
M		$20.00
L		$20.00
XL		$20.00
XXL		$20.00
XXXL		$20.00

Item subtotal:$0.00

Adult: ADD Crew SweatshirtEnter the number of crew sweatshirts you would like to add to your registration.

$30.00

Size	Quantity	Price
S		$30.00
M		$30.00
L		$30.00
XL		$30.00
XXL		$30.00
XXXL		$30.00

Item subtotal:$0.00

Adult: ADD Hooded SweatshirtEnter the number of hooded sweatshirts you would like to add to your registration.

$30.00

Size	Quantity	Price
S		$30.00
M		$30.00
L		$30.00
XL		$30.00
XXL		$30.00
XXXL		$30.00

Item subtotal:$0.00

Children

Child Registration (includes t-shirt)Please enter the number of participants under the age of 18 you would like to register and receive a T-Shirt.

$10.00

Size	Quantity	Price
Kids XS (2-4)		$10.00
Kids Small (6-8)		$10.00
Kids Medium (10-12)		$10.00
Kids Large (14-16)		$10.00

Item subtotal:$0.00

Child: ADD Hooded SweatshirtPlease enter the number of participants under the age of 18 you would like to receive a Hooded Sweatshirt.

$30.00

Size	Quantity
Kids XS (2-4)
Kids Small (6-8)
Kids Medium (10-12)
Kids Large (14-16)

Item subtotal:$0.00

Additional Donation

Would you like to donate an additional amount?

$10.00 Additional Amount

Shipping

ShippingIf you would rather have your t-shirt(s) mailed to you instead of picking up, please indicate here.

$5.00

Total

$0.00

Donations "In Memory Of" or "In Honor Of" loved ones:

If you made an additional donation and would like it to be in memory of or in honor of someone, please indicate below:

	Name of Individual
In Memory Of
In Memory Of
In Memory Of
In Honor Of
In Honor Of
In Honor Of

Breast Cancer Survivors

I have previously been diagnosed with breast cancer and wish to be recognized as a breast cancer survivor.N/A
Number of years as a breast cancer survivor:

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

21st ANNUAL FRIENDS FOR LIFE BREAST CANCER AWARENESS WALK

Donations "In Memory Of" or "In Honor Of" loved ones: