Full Name		Phone Number
Team Name		T-Shirt Size - Youth	(S) (M) (L)
Email Address:		T-Shirt Size - Adult Note: For those who raise $100 or more, you get a T-Shirt!!! Yay!!	(S) (M) (L) (XL) (XXL) (XXXL)
Address
City		Send me a walker brochure	Yes    No
State		I Plan to Walk:	In Springfield   Virtually
ZIP		Team Leader