Muddy Buddy Run Registration for BGMC Pledgers

September 22, 2018/ 8:00 AM | Please fill out this form and click submit.

Name

*

Date of Birth

*

Gender

*

Please select one option.

Female Male

Email

*

This address will receive a confirmation email

Phone

*

Address

*

A/G Church Name

*

Church Address

*

Age Group

*

Please select all that apply.

Little Tykes 5-6 Juniors 7-9 Tweens 10-12

T-Shirt Size

*

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge Adult XXXL

Family Name

*

Number of Adults Attending Celebration Lunch

Adult Lunch Payment

0 Adults ($0) 1 Adult ($5) 2 Adults ($10) 3 Adults ($15) 4 Adults ($20) 5 Adults ($25) 6 Adults ($30) 7 Adults ($35) 8 Adults ($40) 9 Adults ($45) 10 Adults ($50)

Amount

Payment $15.00

Description

September 22, 2018/ 8:00 AM

Please fill out this form and click submit.

Please Fix the Following

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