Saturday, October 21, 2017 9:30 am – 3:00 pm Gough Park 1201 N Pope St Silver City 88061 REGISTRATION no cost. Donation of $15 for T-shirt includes a GRAND prize ticket for EACH T-shirt Donation. Order more than than 3 T-shirts and they’re only $10 Sponsored by: Required Registrant InformationPrimary Contact Name* First Last Primary Contact Email* Enter Email Confirm Email Primary Contact PhoneName(s) of other individuals registeringList one name (First Last) per line.Name(s) of person(s) with Down syndromeList one name (First Last) per line.How many t-shirts do you want?No Shirts12345678910Each T-shirt donation includes a GRAND prize ticket.Shirt SizesAvailable sizes: Youth Small, Youth Medium, Youth Large Small, Medium, Large, X-Large, XX-Large, XXX-LargeExample for 5 shirts: 2 youth small, one large, two mediums.Total $0.00 Payment MethodHow would you like to pay?Credit CardBy Check / Money OrderBilling Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Waiver:In consideration of me and/or my minor child being permitted to participate in the Buddy Walk, I hereby-for myself, my heirs and personal representatives-assume any and all risks which might be associated with the event. I further waive, release, discharge and covenant not to sue The Arc’s Family Support Network of Silver City and Deming, NM. It’s board, employees, sponsors, organizers, volunteers, or other representatives or their successors and assigns, for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child as a result of taking part in the events and any related activities. I also authorize the use by The Arc’s Family Support Network of Silver City and Deming of any photo, film or videotape taken of me or my minor child at the event for any purpose. Yes, I agree Make check Payable to: The Arc of New MexicoAttn: Buddy Walk® PLEASE mail or turn in your donation and this registration form by September 30th 2017Mail to: Vicki Galindo - Community Advocate 2416 Village Dr. Silver City, NM 88061-7117 This iframe contains the logic required to handle Ajax powered Gravity Forms.