Register for a Gaucher Walk/Run Event

Name of Event:

Date of Event:

Location of Event:

Your Name:

Your Organization:

Your Email:

Number of Attendees:

Names of Attendees:

Advance registration:
Children 2-12 years:
Children under 2 years:
Registration day of event:

$30
$10
Free
$35

Registration Amount:

$ (Sponsors do not pay to register*)

Sponsor Name:

(Sponsors only*)

Sponsorship Levels:
Bronze: $250-$499
Silver: $500-$999
Gold: $1000 +

*Sponsors of the Gaucher Walk do not have to pay a Registration Fee. After selecting your free T-Shirt size, please fax this registration form to Megan at 770-934-2911, as this online payment form is set up to accommodate those making credit card payments.

I would like to make an additional tax-deductible donation in the amount of $

I can't attend the event but I would like to donate $

Payment Method:

Please note number and size of T-Shirt(s):

	Small Child T-Shirt(s)
	Medium Child T-Shirt(s)
	Large Child T-Shirt(s)
	Small Adult T-Shirt(s)
	Medium Adult T-Shirt(s)
	Large Adult T-Shirt(s)
	XL Adult T-Shirt(s)

Please click the "Continue" button below to register and pay.

If you'd like to hold a a walk or run in your own city contact Megan Kirby at megan@gaucherdisease.org or 800-504-3189.

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National Gaucher Foundation
2227 Idlewood Road, Suite 12
Tucker, GA 30084
800-504-3189