Name(Required) First Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Birthdate(Required) MM slash DD slash YYYY T-Shirt Size (if you raise $50.00 or more) M L XL XXL I am participating as:(Required) Individual Walker ($5 registration for adult; registration waived for child under 18) Team Member Walker/Team Name I cannot attend Recovery Walks! but have enclosed my donation in the amount of $_____ Name(Required) First Amount of $(Required)Enclosed is Registration fees and/or donation for:(Required)Pay method(Required) Check Cash Credit Card Credit Card(Required) Visa Mastercard Discover American Express *** Please make all checks/money orders payable to The Council of Southeast PA and mail to 4459 W. Swamp Road, Doylestown, PA 18902 Your contribution is 100% tax deductible. Thank you!Donation(Required) Donate online Donate by Mail CAPTCHA Δ
