Conference Registration Form with Payment

Annual 2 Mile Walk- Registration Form

Our Health, Wellness and Economic Empowerment event celebrates improving our communities, expanding sustainable healthy practices and empowering personal growth. Come and enjoy Free gift bags, Food and fun for all!!!
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Telephone #

Area CodePhone Number
Cell Phone #*

Area CodePhone Number
Adult T-shirt Sizes

SmallMediumLarge2XL3XL
Children T-shirt Sizes

SmallMediumLarge
Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.
My Products*
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Registration$20.00

Quantity

Donation$10.00

Donation Amount

Total $0.00
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Annual 2 Mile Walk- Registration Form