ACTion Walk - Team Registration ACTion Walk Team Registration form. Walk benefits the Achievement Center of Texas a 501(c)(3) Texas corporation. Ready to Register Your Team?YesNoTeam of 5 walkers - $150.00* Price: $150.00 Total $0.00 This is the total amount for your registration or donation. As you make additional choices your total will change.Team of 5 Ghouls for 5KTeam of 5 Ghouls for 5K A t-shirt size field will display next to the name. We will do our best to have selected sizes but they cannot be guaranteed for registrations after October 8, 2015 Price: $150.00 Team NameTell us your team name!Do you want to help us raise funds in the name of your team?*If you want a team page to encourage donations to ACT, choose "Yes" and we will setup a page for you with a link you can send to supporters.YesNoGhoul 1*Ghoul 1 Shirt Size*Ghoul 1 Shirt SizeSmallMediumLargeXLGhoul 2*Ghoul 2 Shirt Size*Ghoul 2 Shirt SizeSmallMediumLargeXLGhoul 3*Ghoul 3 Shirt Size*Ghoul 3 Shirt SizeSmallMediumLargeXLGhoul 4*Ghoul 4 Shirt Size*Ghoul 4 Shirt SizeSmallMediumLargeXLGhoul 5*Ghoul 5 Shirt Size*Ghoul 5 Shirt SizeSmallMediumLargeXLWe need more information....Name* First Last Address* Street Address City Your StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CompanyIf this is a corporate sponsorship or tickets are being purchased by a company or organization, please provide the name here.Phone*Please provide a telephone number (cell number preferred) so we can contact you if additional information is needed.Email*Please provide the email address for the contact person. We will use this email address to communicate with you about your registration. Please check the box below if we can use this email address for other projects. Note: If you are already on our email list, checking no will not remove your email but you can use the unsubscribe link on emails from us to be removed. Advertising Note: Team advertising includes website mention and listing in printed materials if signed up by October 10, 2016. The marketing coordinator will contact you using the information shown later in this form.Future Email Use Consent*We would like to send occasional emails about activities and events to the email shown above. We do not share, sell or lease your information. You will always be given the option to opt out of future emails.YesNoAdditional InformationPlease enter comments or questions below:Payment Method*Credit CardPay by checkYour registration will be recorded. You will be contacted if there are questions or if your check isn't received. Please mail checks to: Achievement Center of Texas Attn: ACTion Walk Team Registration PO Box 452826 Garland, TX 75045-2826 Or, bring your check to 2950 N. Shiloh Rd., Garland, TX 75044 If possible, please print this page and include with your check.This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.