Building Leaders One Step at a Time Application

Attendance(Required)

I want to participate in the (select one option):(Required)

1-mile walk

3-mile hike

Donation Amount(Required)

$10-16 & under

$15-College Student

$15-No T-shirt

$25

$50

$100

Custom Amount

Please enter a number greater than or equal to 10.

Custom Amount

Please enter a number greater than or equal to 1.

In-person attendees will receive a long-sleeve “Building Leaders One Step at a Time” shirt with your donation of $25.00 or more, as well as a surprise gift with donations of $50.00 or more.

Register by August 27, 2023 to secure a “Building Leaders One Step at a Time” shirt (after this date, we cannot guarantee availability of supplies and size preference).

Receive a long-sleeve “Building Leaders One Step at a Time” shirt with your donation of $50.00 or more.

Register by August 27, 2023 to secure a “Building Leaders One Step at a Time” shirt (after this date, we cannot guarantee availability of supplies and size preference).

Size Preference (select one option)(Required)

All shirts are unisex.

Register someone else?

Yes

No

Size Preference (select one option)

All shirts are unisex.

Name

First Last

Register someone else?

Yes

No

Size Preference (select one option)

All shirts are unisex.

Name

First Last

Register someone else?

Yes

No

Size Preference (select one option)

All shirts are unisex.

Name

First Last

Register someone else?

Yes

No

Size Preference (select one option)

All shirts are unisex.

Name

First Last

Register someone else?

Yes

No

Size Preference (select one option)

All shirts are unisex.

Name

First Last

Register someone else?

Yes

No

Size Preference (select one option)

All shirts are unisex.

Name

First Last

Donation Total

Price: $0.00

Contact Information

Name

First Last

Shipping Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Were You Referred By Someone?

Yes

No

Who Referred You?

Billing Address

Same as Shipping Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total

Comments

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