Gundersen Lutheran Online

One name per entry form. Complete and submit by Monday, Aug. 25, 2008.
You may also register in any of the following ways:: - In the Foundation 9 a.m.-4 p.m. any weekday, 3rd Floor, Main Clinic.; - Day of the Walk. or by Printing and mailing the form; - Click here if you need help filling out this form.

Personal Information
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Phone:

Team Information
Team Name:
Team Captain:
Your Employer:

Registration type and t-shirt selection

Details
Gender: F M  Age:
Adult Registration $15
T-Shirt: Youth (8-10)    S    M    L    XL    XXL    None

Youth Registration $5
T-Shirt: Youth (8-10)    S    M    L    XL    XXL    None
(please note that all t-shirt sizes are adult except youth 8-10)

Ages 0-4 Free (No T-shirt)

Additional Donation
$25 $50 $75 $100 $150 $200 $500

At the $75 level of donation, you will receive: an aluminum sports bottle!
At the $150 level, you will receive: an aluminum sports bottle and a Steppin Out in Pink cooler sling pack!

Note: To add additional walkers to your registration, use the "Register another walker" button from the shopping cart. All registrations will be charged to your card during checkout.