Registration Form

Splashin' for a Reason

Event Registration Form
To take the Splash you need to raise $40 and complete the form below. That’s it!
Please complete the form below + send with check payment to :

The Winter Miracle Splash c/o Amanda Pribek

5215 Stone Road - Whitelaw, WI 54247
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Splashing with a team? Enter your team name below:
Walk up Song (Optional)
Shirt Size

SMLXLXXLXXXL
By registering for this event, you are agreeing to allow the Splashin’ for a Reason Committee to use all even related photography & video for advertising needs.

*Refund Policy: Charitable contributions are non refundable, and the minimum Winter Miracle Splash fundraising requirement is considered a charitable contribution and is therefore also non-refundable.
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Splashin' for a Reason