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2017 Superhero Run/Walk Registration Form
Amount
*
Quantity
$25
-
Individual
0
1
2
3
4
5
6
7
8
9
10
10
$20
-
Team/Family (3-10 people)
0
1
2
3
4
5
6
7
8
9
10
10
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Team Name (Required for family/team registrations)
Names of all family/team members, if applicable
T-Shirt Size(s)
*
(if you raise $100 in pre-pledges and they are received by April 29, you receive a free t-shirt!)
Add 3% to my total amount to help cover the payment processing fees
