Team or Individual Registration Form
Team Captain
:
(Individual Participant Name)
Address
:
Team Name
:
City
:
Phone
:
Province
:
E-mail
:
Postal Code
:
Contact Preference:
Phone
E-mail
No preference
Registration Fee - $5.00 per person. You can supply your own high heeled shoes or shoe rental is available for $15/pair.
OR WaM BUNDLE ... Registration, Shoe Rental plus Walk A Mile T-shirt $25.00
(Limited quantities of shoes and tshirts available - requests filled as registrations are received).
Team Members Name
Phone #
WaM Bundle
Registration Fee
Shoe Rental?
Shoe Rental Fee
Mens Shoe Size
(Captain)
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
$25.00
$5.00
$15.00
+
=
TOTAL FEES
$0.00
$0.00
+
$0.00
$0.00
These fees are not tax deductible
We respect your privacy. Royal LePage ProAlliance Realty, Brokerage and The Royal LePage Shelter Foundation uses your contact information solely for the purpose of staying in touch with you with respect to this event. We do not trade, sell, or share participant or donor information. If you have a preference for the way our team will communicate with you, please be sure to indicate that above.