Survivor Crop 2010 Registration

About You
First Name:
Last Name:
Address:
Address Continued
City:
State:
Zip Code:
Home Phone:  [999-999-9999 format]
Work Phone:  [999-999-9999 format]
Email:
T-shirt Size:
Registration Fee Due
Donation Goal
Payment Options 
If you have not used PayPal before, please visit www.paypal.com to make sure this is the option you wish to use. Please Note Registration Fees are Non-Refundable.
Make me the Hostess.
Choose your island  (Double click on island to view availability & members)
Only 12 members per team.
 
Information for the Event
Do you want to be identified as a breast cancer survivor?
How did you hear about us?
If Other, please specify:
Emergency Contact
Emergency Phone
Sign Up for $500 Club
Past Participant
2002 2003 2004 2005
2006 2007 2008 2009
Sandwich Choice

Note: Items in pink require input 

 

If you have any questions or problems with your registration, please contact

Camille Akin 760-630-CROP (2767) or email info@everafterscrapbooks.com

 
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