2011 MIKE-A-THON REGISTRATION
Questions:
mikeathon@mikeathon.com
Name:
Address:
City:
State:
Zip:
Email Address:
Preferred Telephone:
Participant Information (check all that apply):
Age 14 and under
Age 15 to 18
Age 19 to 65
Age 65 and older
Female
Registration level (check which applies):
100 Targets and lunch for $100 ($115 on day of event)
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50 Targets and lunch for $60 ($70 on day of event)
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50 Targets and lunch for child $50
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Lunch & beverages only $30
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Total:
Registrants under 18 years of age must be accompanied by a parent or guardian
Copyright 2011 © MikeAThon.org
