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):
* 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
* 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