Run4Haiti Registration

Run4Haiti 2013 registration.

Full Name *
Full Mailing Address (please include zip) *
Phone Number *
Email Address *
Male/Female *
MaleFemale
Which are you? *
Youth LeaderHigh School StudentCollege StudentCollege-Aged (but not enrolled)Other
Name of Church or Youth Organization
Important Information: Once this form is submitted, we will contact you and send you the forms that need to be completed and brought with you to the event. If you are bringing a group, please list the names of the rest of your group members in the fields below. Youth Leaders are encouraged to attend with their groups, and are not required to pay the initial $60 event fee. They will, however, be required to participate in fundraising to receive other items throughout the event. Anyone under the age of 18 must have the name and signature of a parent or legal guardian on the registration form and the event waiver. This should be verified by the Youth Leader before registering at the actual event. If you have any questions about this event that are not answered on the website, please feel free to contact Kimberlie Todd @ 567-208-7798, or via email at Kimberlie@OurMissionIsPossible.org.
Name of Student #1
Name of Student #2
Name of Student #3
Name of Student #4
Name of Student #5
Name of Student #6
Name of Student #7
Name of Student #8