Team Registration

Use the form below to register your team.  Here are a few tips:

• Let your team know the goal you have set – once they are aware of how much you hope to raise, they will be motivated to help you reach that goal.
• Encourage them to visit our website www.alzca.org to learn more about our programs for help families struggling to care for a loved one at home.
• Remind them of the Walk t-shirts! Receive a short-sleeved shirt with your $50 donation or a long- sleeved shirt for a $75 donation.

Walk Team Registration

Team Pledge ($) (This will be displayed on the Walk Team Progress page)

Team Name (Displayed on the Walk Team Progress Page) *

Team Leader *

Address (line one)

Address (line two)

City

State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Phone Number

Email Address

Optional Comments (any instructions you would like to include)

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Please submit this form via the submit button below. You will be contacted shortly. If you need immediate assistance or would like to confirm that your form has been processed, please call us. 205-871-7970.

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