Step Up 4 Haiti Walk-A-Thon Registration Form

On January 12, 2010, a series of earthquakes with magnitudes ranging from 6.5 to 7.3 devastated the island
nation of Haiti. A month later the death toll has topped 200,000, with 250,000 others in urgent need of
assistance. Additionally, 2,000,000 people in Haiti are now homeless. All of these people are in need of your
help, so please sign-up for the

Step Up 4 Haiti Walk-A-Thon

and do your part to help Haiti. The Walk-A-Thon will be held on March 19th from 6:00-10:00 p.m. in the
CCHS Cafeteria; your attendance is not required to take part in this fund raiser. All funds raised will be
donated to the

American Red Cross Haiti Relief Fund.

Participant: ________________________________________________________ Date: __________________

E-Mail Address: ____________________________________________________________________________

Student ID: ____________________ Grade: ________ Cell Phone #: ________________________________

If you are registering non-CCHS family members and/or friends please list their names below:

_________________________________________________________________________________________
_

Registration (the deadline to order a t-shirt is March 9, 2010):

__________ Number of people registering x $2.00 each $_______________________

__________ Number of Step Up 4 Haiti t-shirts requested x $5.00 each

$_______________________

T-shirt sizes needed (S, M, L, XL, XXL): ____________________

Total amount enclosed: $_______________________

Please return this form to the activities window at Central Crossing, along with your payment.
At that time, you will receive all Step Up 4 Haiti Walk-A-Thon information, including your
collection form and envelope. If you have questions, see Mrs. Mussi in room 170.
Thank you for signing up!