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Please fill in all required information. Then click submit button at the bottom
of this form.
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Questions and comments may be entered at the bottom of this form
as well. |
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When done with registration, you can go to link at bottom of
page and pay using |
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Pay Pal or Credit Card, or send a check to the address listed
below. |
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Contact
information for person responsible for registration fee/fees is: |
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*First Name |
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*Last Name |
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Middle Initial |
optional |
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*Street Address |
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*City |
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*State/Province |
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*Zip/Postal Code |
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*Contact Phone |
(Including area code) |
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2nd Contact Phone |
optional |
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FAX |
optional |
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*E-mail |
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URL |
optional |
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List Team members Here: |
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(Please specify if they are a child or adult. If a child, please note their
age. Include |
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if they are a ride participant by noting, "ride" or
"no ride". Please also include
DS for |
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participants with Downs Syndrome.) |
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Sample 1 |
Joan Smith, adult, no ride |
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Sample 2 |
James Smith, adult, ride |
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Sample 3 |
Johnny Smith, child, age 2, no ride |
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Sample 4 |
Mary Smith, child, age 8, ride, DS |
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Note,
If you have exceeded the lines above additional names may be added in this |
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box below. (Please include child or adult info, as explained above, and separate |
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specified information with a comma.) |
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Please note total of extra donations (if
applicable) in box below. |
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In the box below, please type in your totals in the format
as shown. |
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Participation Fee:
Participant with ride
bracelet $25 X _______ = $________
Participant without ride
bracelet $15 X ______= $________
Participant with Down
syndrome* $0 X _____ = $___0____ *No
Participation fee for our loved ones with Down syndrome. This day is to raise
awareness for
Any extra donation to 21
Down included = $________
them, so they will be able to enjoy all of the
days events for free!
Total
included $_________ Please
make checks payable to: 21 Down
---All
participants that register and pay participation fees either online or by mail
before 10/6 will receive a special prize at the walk---
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You many also note any questions, concerns, or general comments in this section. |
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After you submit
your team information, please mail payment to:
21 DOWN
P.O. Box 205
Northfield, NJ 08225
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