Please complete the following information so that we can collect accurate information for sponsors, organizers and group leaders.
Required fields are marked with a red asterisk(*)
Participant Registration Form
*
Please register me under the group:
*INDIVIDUALS/No Group Affilliation
4 Seany Boy
A + Academy
AFIL
AHS
Arc of Dallas
At Home Healthcare
Autism Treatment Center
Best Buddies SMU
Bishop Dunne Catholic School
Brown's Power Generation
Brown's Power Generation
CALAB
Citizens Development Center
Community Homes for Adults, Inc. (CHAI)
CSP Health Services
Dallas Center
Evergreen Presbyterian Ministries
Galloway Gators
Garland High School
GHS Student Council
Irving ISD
JHHS
Lake Ridge SKILLS Stars
Lakes Regional MHMR Day Habilitation Center
LaunchAbility
LAWSON PTA
LifePath Systems
LULAC Youth
M. PRITCHETT & ASSOCIATES
Mary"s House
MCHS LULAC
MCHS LULAC
McKinney North High School AVID
Mesquite Mavericks
Metrocare Services
Mosaic in Corsicana
Mosiac
NewLife Family Care Services
North Texas Rehabilitation Services
Notre Dame School
Our Children's House at Baylor
Parish Episcopal ASTRA Club
Parish Episcopal School
Plano East
Sam Houston High School
Shepton High School
Texas Instruments
Therapy 2000
Theresa Francis
United Advocates
Volunteers of America-Texas
West Mesquite Wranglers
My personal information is:
*
Full Name:
*
Address:
Address (cont'd):
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City:
*
State:
None
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
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Zip Code:
*
Gender:
Male
Female
Age:
Phone Number:
*
Email Address:
*
Best way for my group leader to contact me if needed:
Email
Phone
Are you on Facebook?
Yes
No
*
Are you a First Time participant?
Yes
No
I want to register these family members who live at this address indicated above:
Name
Gender
Age
First Time Participant
Male
Female
Yes
No
Male
Female
Yes
No
Male
Female
Yes
No
Male
Female
Yes
No
Male
Female
Yes
No
Male
Female
Yes
No
Male
Female
Yes
No
Male
Female
Yes
No