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________________________________________________________________

1.
2.
3.
4.
5.
6.
7.
8.

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
9.
10.
11.
12.
13.
14.
15.

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.