Registration for Walkathon

Registration for 5K Walk

5K Walk Against Domestic Violence

Name *
Address
Phone Number
Email *
Age *
Date of Birth
Program you are participating in 5K Walk5K Run
T-Shirt Size (additional $10)
Other I am unable to run/walk, but I would like to make a donation to the CORESSWC - AWS Abused Women Support
Confirmation I understand the risks involved in participating in the CORESSWC/AWS Walk and willingly and voluntarily accept these risks. I attest that I am physically fit and prepared for this event. I grant permission for the organizers to use photographs/images and quotations from me in accounts and promotions of this event.

Pay Admission Fee through PayPal or Zelle

**Insert "2019 AWS 5K" in memo for PayPal**

Additional processing fee applies when using Paypal.

Guest Donations by Mail:

Guest Donations by Credit Card:

Mail check donations 15 days (ENVELOPE STAMP DATE) before the discount date made payable to CORE SPIRITUAL AND WELLNESS P.O. BOX 303, WEST ORANGE NJ 07052. IN THE MEMO OF THE CHECK SPECIFY 2019 AWS 5K

Call (973) 370-3440