Printable Team registration form

Register Your Team for walk MS 2013
presented by GIANT Food Stores
Mail registration form to:
National MS Society, Central PA Chapter
2040 Linglestown Road
Suite 104
Harrisburg PA 17110
or Fax to: 717-652-2590
Please print in black ink or pencil
Photocopy this original as needed to register
more team members!
TEAM NAME:
TEAM CAPTAIN:
TYPE OF TEAM (Please circle one): Organization School Friends & Family Corporation
WALK SITE: __________________________________________________________________________
Team Captain Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).
Who are your team members? Please include complete information on each team member.
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).

TEAM NAME: WALK SITE :
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).

TEAM NAME: WALK SITE :
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).

TEAM NAME: WALK SITE :
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).
Name:
Street Address:
City: State: Zip:
Address Type (Please circle one): Home/Business/Seasonal or Temporary Date of Birth:
Phone: (hm)
(wk)
T-shirt size (please circle one): S M L XL XXL Sex: M F
(Please note: T-shirts are offered to those who raise $100 or more for walk MS)
Employer:
Email address:
I would like to pick up my Walker Info Packet online (email address required).