5K Bullying Prevention Walk

September 22, 2012

8:30 a.m.-11:00 a.m.

(Walk starts promptly at 9 a.m. at Spanish Plaza)

CONTACT INFORMATION
Team Name__________________________________________________________________
Team Leader_________________________________________________________________
Address_____________________________________________________________________
City___________________ State______________ Zip Code__________________________
Home Phone______________________________ Cell Phone__________________________
E-mail Address________________________________________________________________
TEAM MEMBERS
AVAILABLE T-SHIRT SIZES (Youth: S,M,L or Adults: S, M, L, XL, XXL) Directions: Write Y
or A & S-XXL EXAMPLE: YS
NAME
T-SHIRT
NAME
T-SHIRT
SIZE
SIZE
1.
9.
2.
3.

10.
11.

4.

12.

5.

13.

6.

14.

7.

15.

8.
PAYMENT AND REGISTRATION:
Please make sure to fill in the appropriate team member sections above:
Return this registration form with a check or money order made payable to Crittenton
Youth Services. The registration fee is $5 for youth and $15 for adults. The
registration fee includes the event t-shirt.
Please send your registration and payment to Crittenton Youth Services, 30
Schillinger Rd. N. Suite 105 Mobile, Alabama 36608. For more information, send an
email to Joy Logan at jlogan@crittentonyouthservices.com. Registration deadline
is September 3, 2012.