FIRST PERSON
I AM A MEMBER-IN-GOOD-STANDING -A member in good standing is a friend of Running Strong for American Indian Youth® who has donated to our important cause in the past calendar year. If you have any questions about your status or would like to become a Member in Good Standing, please call *
Y esN o
First Name: *
Last Name: *
Title (Mr./Mrs./Miss/Ms.): *
Name you would like to be called - will be on your name tag:
Your Gender (for hotel accommodations): *
M aleF emale
Your Street Address: *
City: *
State: *
Zip Code: *
Phone Number (with area code): *
Date of Birth (MM/DD/YEAR): *
Email Address: *
EMERGENCY INFORMATION
Allergies (please explain if applicable):
Health Problems (please explain if applicable):
Emergency Contact's Full Name: *
Emergency Contact's Relationship:
Emergency Contact's Phone Number (with area code) *
T-Shirt Sizes (all of the t-shirts come in male sizes) *
S MM DL GX LGX XLGX XXLG
** MULTIPLE PARTICIPANTS ** If you have more than one participant that you would like to sign up, please continue with this registration, there will be an area to sign them up below. Thank you!
SECOND PERSON (if applicable)
(2nd person) First Name:
(2nd person) Last Name:
(2nd person) Title (Mr./Mrs./Miss/Ms.)
(2nd person) Name you would like to be called - it will be on your name tag
(2nd person) Your Gender (for hotel accomodations):
M aleF emale
(2nd person) Street Address:
(2nd person) City:
(2nd person) State:
(2nd person) Zip Code:
(2nd person) Phone Number (with area code):
(2nd person) Date of Birth (MM/DD/YEAR):
(2nd person) Email Address:
(2nd person) EMERGENCY INFORMATION
(2nd person) Allergies (please explain if applicable):
(2nd person) Health Problems (please explain if applicable):
(2nd person) Emergency Contact's Full Name:
(2nd person) Emergency Contact's Relationship
(2nd person) Emergency Contact's Phone Number (with area code)
(2nd person) T-Shirt Sizes (all of the t-shirts come in male sizes)
S MM EDL GX LX XLX XXL
HOTEL ROOM REQUEST: At several tour hotels the majority of the non-smoking rooms are on the second floor, which involves walking up one flight of steps. Staff will be available to assist you. Please note if you have a room preference and we will make every attempt to accommodate you.
D ouble RoomS ingle RoomP lease try to provide me with a roommateN on-smokingS mokingR oom on the 1st floorR oom on the 2nd floorN o preference
Confirmation of your reservation and a receipt of full payment or invoice based on deposit will be sent to you as soon as we have received your registration. A complete information packet will be sent approximately one month before the tour begins. All reservations are accepted on a first-come, first served basis. Final payment must be received in full by August 1, 2008.
PRESS THE SUBMIT BUTTON AT THE BOTTOM OF THIS PAGE WHEN DONE.
PAYMENT OPTIONS
-- You Can Pay Online*
*Once you click the submit for this form, you will be given a link and opportunity to pay on-line. *On-line payment is recommended but not required.
-- You Can Pay/Register By Mail
Print out and complete this registration form and mail with payment to:
Running Strong for American Indian Youth®
Attn: Reservation Tour 2007
2550 Huntington Avenue, Suite 200
Alexandria, VA 22303
-- You Can Pay Over the Phone
Submit the registration seperately and call us at (703)317-9881 to pay by credit card.
-- Fax Registration Information
You can complete and print the registration form and fax, along with credit card information to: (703)317-9690
