Last Name
First Name
Middle Initial
Mailing Address
Apt./Suite #
City/Town
State
Zip Code
Home Phone
Work Phone
Extension
Email
Employer/School/Organization
We are walking as a: School Team Company Team Faith team Family Team Other Team type
Team Name
Team Leader’s Name
Fundraising Goal: $
T-Shirt Size: Small Medium Large X- Large XX - Large
Sex Male Female
How many years have you participated?
My company has a matching gifts program.
I am interested in: Organizing a walk team Learning about volunteer opportunities with CCSJ
I cannot attend, but I am donating to CCSJ
