MS Warrior Walk Registration

Name

First

Last

Phone

Email

Date of Birth

Emergency Contact Name

Emergency Contact Phone Number

What is you personal connection to MS?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Make a Donation ( $25 or more gets a free shirt while supplies last)

Your Donation Amount. Suggested Amount $25

Payment Method

Card Number

Expiration Date

Security Code

Card Holder Name

Contact $25 is

waiver

I acknowledge and represent that I have carefully read and understand all terms of the El Paso MS Community Event Release and Waiver of Liability. I am legally competent to sign this agreement for myself and/or on behalf of the minor listed in the Registration.

Saturday,