EmailMe Form - FaithWORKS Step Up to Health Registration

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email

Please select which event you plan to participate in *

2 Mile Run/Walk

TakeOVER Youth Fundraise 2 MI Run/Walk

Kids Get Fit Fun/Walk

If participating in youth activities, please list each child's name and age

T-shirts are included with registration which is $20.00

T-Shirt Size *