FINDcures – Walk & Talk

Registration Fee*
- $75.00
Neurological Interest (Select One):*
Name*
First Last
Email Address*
Cell Phone #*
Street Address*
City*
State*
ZIP Code*
Country*
Gender*
Mobility Assistances Needed:*
- No
- Yes
Age (Optional):
Emergency Contact Name*
Emergency Phone*
T-Shirt Choice*
T-Shirt Size*
Donation: Your donation will be use to help people with a neurological issue find the right support services to bring hope to their situation. All donations are greatly appreciated. Thank you.
Comments:
Coupon Code:
Total
$0.00