Walk Registration

Contact Information

First Name:

Last Name:

Street

Apt.

City:

State:

Country:

ZIP/Postal Code:

Phone: e.g. (555-555-5555)

Business Phone:

e.g. (555-555-5555)

Cell Phone:

Email:

My company/organization will have a team at the Walk

Company Name:

(please complete a separate form for each walker)

In addition to walking, I would like to help produce the event. I am available to volunteer (please check all that apply):

T-shirt Size

Gender:

Age Range:

How did you hear about FOTAS Tobago AIDS Walk

Payment Options

MAIL FORM AND PAYMENT OR CLICK AND SEND PAYMENT ONLY TO:

FOTAS Tobago

6 DOUGLAS TRACE

HOPE VILLAGE, TOBAGO, W.I.