Walker Registration

Walker Registration
A BLD Newark Mission Walk Fundraiser 2014

Go back to ... in His footsteps ... page

Step 1 (please complete the required fields *)

BLD Newark Mission Walk
Johnson Park (3K)
Piscataway, NJ
August 9, 2014.
Start time: 8:00 am sharp
Check-in time: 7:00 am

Walker Registration Fees are as follows: Adults 19 & over: $30
Youth 13 - 18: $20
Kids 12 & under: $5 **

Please note that your walker Registration Form submission will not be processed until the required amount has been paid. See Step 2 below for payment methods.

Please note that check-in time for participants is 7:00 am. Failure to do so may result in a late start. Walk starts promptly at 8:00 am.

** Registration fees for kids12 and under are mainly to defray the costs of the T-shirts. They need not register to walk if they do not want the T-shirt.

* Indicates required field

Walker 1 (Captain) *

First

Last

1 - Email (Captain) *

1 - Phone Number (Captain) *

1 - Walker Category *

1 - Adult T-shirt Size *

1 - BLD Member? *

You can add up to 9 additional walkers in the family or group under the Captain who will be responsible for all payments and communications

Walker 2 *

First

Last

Walker 3 *

First

Last

Walker 4 *

First

Last

Walker 5 *

First

Last

Walker 6 *

First

Last

Walker 7 *

First

Last

Walker 8 *

First

Last

Walker 9 *

First

Last

Walker 10 *

First

Last

2 - Walker Category *

3 - Walker Category *

4 - Walker Category *

5 - Walker Category *

6 - Walker Category *

7 - Walker Category *

8 - Walker Category *

9 - Walker Category *

10 - Walker Category *

Total Registration Fee (including Walker 1) *

2 - Adult T-shirt Size *

3 - Adult T-shirt Size *

4 - Adult T-shirt Size *

5 - Adult T-shirt Size *

6 - Adult T-shirt Size *

7 - Adult T-shirt Size *

8 - Adult T-shirt Size *

9 - Adult T-shirt Size *

10 - Adult T-shirt Size *

2 - BLD Member? *

3 - BLD Member? *

4 - BLD Member? *

5 - BLD Member? *

6 - BLD Member? *

7 - BLD Member? *

8 - BLD Member? *

9 - BLD Member? *

10 - BLD Member? *

Additional T-shirts @ $15 can also be purchased separately.

Note: The deadline for submission of choices for T-shirt sizes is July 18, 2014. Submission of choices after this date will be on a "while supplies last" basis.

S - Quantity *

M - Quantity *

L - Quantity *

XL - Quantity *

XXL - Quantity *

S - Amount *

M - Amount *

L - Amount *

XL - Amount *

XXL - Amount *

Grand Total (including Registration Fees) *

Payment Type *

PayPal*** Check*** Pledge

*** IMPORTANT ***

If 'PayPal' is selected, please complete Step 2 below and make sure that Walker 1 name above matches the PayPal name to be properly registered.

If 'Check' is selected, please make it out to BLD Newark and mail to:

BLD Newark
P.O. Box 139
114 Oak Tree Avenue
South Plainfield, NJ 07080

Comment *

Waiver *

I and on behalf of the group (if any), hereby agree not to hold BLD and all its representatives, agents, and sponsors liable for any injuries or damage to personal belongings that may occur while participating in this event and do so at our own risks.

Fitness & Release *

I attest and verify that the group members (if any) and I are physically fit, and have sufficiently conditioned for completion of this event. Further, I and on behalf of the group (if any), hereby grant full permission to any and all forgoing to use our name(s), photographs, videotapes, motion pictures, recordings or any other record of the event for any purpose whatsoever without charge.

After clicking the submit button below, the form will "disappear" and confirm your submission. Otherwise, you have NOT filled in ALL the required fields * and you have NOT been registered yet.

Submit

Step 2

(Click the 'Donate' button below now to pay via the secured PayPal website. Please make sure the Walker 1 name matches the PayPal name to be properly registered for the walk.)

All major credit cards accepted.

To pay by check, please make it out to BLD Newark and mail to:

BLD Newark
P.O. Box 139
114 Oak Tree Avenue
South Plainfield, NJ 07080

Thank you for your generous support. 100% of the funds are used for our mission
and charity work. Your prayers are most welcomed too. God bless.

BLD Newark is a 501(C)(3)
tax exempt organization.

Step 3

(Walker 1 Captain to complete this step only if you would like to receive any email notifications of the event - recommended)

click here for your free autoresponder