Registration : Jim Gaines Memorial CORD Walkathon 2019 - Hosted by CMTC

When: October 13, 2019
Where: Mercer County Park (East Picnic Area)
Time: 10:00 AM
Refreshments will be served

Donation of $25/walker.

Note: If you are registering more than 5 walkers please fill out an additional registration.
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
Address2
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Phone *
Your answer
Email *
Your answer
Total Number of Walkers *
Person1 *
Your answer
Person1Grade *
Person2
Your answer
Person2Grade
Person3
Your answer
Person3Grade
Person4
Your answer
Person4Grade
Person5
Your answer
Person5Grade
amount *
$25/walker. (Ex: Family of 4 walkers = $100)
Your answer
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