GEMS Girls' Clubs - Girls Everywhere Meeting the Savior

Registration & Pledge Form
Walkers will recieve a t-shirt for each family member that has collected $25 or more.

I am

Name:

Address: City: State/Province: Zip:

Phone: Email:

Walkers, please fill out this portion of the form.

Name: Shirt Size

Name: Shirt Size
Name: Shirt Size
Name: Shirt Size

Name: Shirt Size

Name: Shirt Size

Address: City: State/Province: Zip:

Phone: Email:

Church or GEMS Club:

Area:

Supporters, please fill out this portion of the form.
Name:

Name of walker you are supporting:

Name of church or GEMS Club you are supporting:

Area walker is walking in:

Address: City: State/Province: Zip:

Phone: Email:

Church or GEMS Club (of walker you are supporting):

Payment Information:

Credit Card: Pledge Amount:

Card Number: Exp. Date (mo/yr):

Name on the Card:

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