Team Registration Form Water Walk 2010

Glens Falls Rotary Water Walk 2010

Crandall Park, Glens Falls, NY

Saturday May 8, 2010    

 

Team Registration and Summary Form

                                                                                                                                                                                                                                  

1 - Complete the registration completely. Each box requires a response. Enter N/A if the question does not apply to your team.

2 - A TEAM is defined as a group of two or more participants.

3 - Submit the registration form immediately when complete or call Kay Walter (793-5660) to be registered by phone. A  copy will  be mailed to the team leader for your records.

4 - A YOUTH is defined as a person under the age of 18 or a person still attending High School.

5 - There must be one designated adult chaperone for each youth team. Chaperones must be at least 25 years of age.

6 - Youth team leaders must have their Chaperone complete and sign this form.

7 - Please record any special needs or requests on the back of this form.

8 - We are encouraging flat donations instead of "pledges" for miles walked. Checks are to be made payable to "Glens Falls Rotary Foundation" , a tax deductable, 501c3. All donations should be turned in on the morning of Water Walk 2010 at the registration desk.
9 - We are requesting team donations to be at least $100 for adult teams and if possible, $50 for youth teams, in lieu of registration fees. However, we want to encourage EVERYONE to participate who wants to. These are guidlines only and any team registered may participate regardless of the donated amount.

 

Team Sponsor (Rotary Club, business etc)		Phone #
Address:		Extension:
City - State - Zip:		FAX #

 

Team Name (Please Print)

Special needs or requests listed on reverse of form  (please circle)                     Yes          No

 

Team Captain Name:		Home Phone:
Home Address:		Other Phone:

 

	Name	Address	Adult / Youth	Amount Raised
1			A     Y
2			A     Y
3			A     Y
4			A     Y
Min. 5			A     Y
6			A     Y
7			A     Y
8			A     Y
9			A     Y
10			A     Y
11			A     Y
			Total Raised for Pure Water	$

 

I/We have accurately completed all portions of this registration form.

Team Captain's Signature:                                                                                                      Date:

Chaperone's Signature: (if required)                                                                                                                              Date:

 

 

Meeting Time & Location Information Thursday at 12:15 PM Queensbury Hotel 88 Ridge Street Glens Falls, NY 12801  map it USA	Contact Information Dr. Shelle Kelz phone: 518-743-0773 fax: 518 743-0774 contact us www.glensfallsrotary.com