Students must use this registration form in order to receive a reduced registration fee. Please note you will need to present your student ID at the registration tent the day of the event. Registration will be held from 9:00 - 10:00 a.m. on event day Saturday, April 14th, 2012.

Walk a Mile Event - Student Registration

First Name
Last Name
Team Name (if applicable)
Registrant Gender	Select One Male Female
Do you need a shoe rental? Note: Only male walkers are requested to wear heels.	Select One Yes No
If you need a shoe rental, please list size here. Note: Shoes are in men`s sizes.
Men walkers receive a free t-shirt. Enter shirt size here.
Women walkers: enter size and quantity here if you would like to purchase a t-shirt. Please add $10 for each t-shirt to your total purchase below.
Email Address
Street Address
City
State
Zipcode
Phone Number
For payment amount below, registration fees are $15 for male students and $10 for female students.
Payment Information (* Required Fields)
Payment Description	Walk a Mile Student Registration
* Payment Amount
First Name on Credit Card
Last Name on Credit Card
Billing Street Address
Billing Zip Code
Email
Card Number
Card CVV Code (3 or 4 digits)
Card Expiration (ex 09/2013)
Please wait. Allow up to 2 minutes for processing. Please do not 'refresh' or go 'back' until the transaction is completed and you have received the success or failure message on your screen.