RKC Express Participation - Achievement Center of Texas

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This form is to register for the walk and participate with RKC Express! If you got here by accident, and only want to donate, click here to Donate to RKC Express

Registration Fee

Registration Fee is $30 per person. If only one person is registering, your information is taken below. You are Person 1. The person completing the registration will also accept the walk waiver before completing the form.

1 Person – $30

2 People – $60

3 People – $90

4 People – $100 Team “Special” Pricing!

Person 2

Please provide the name of the second person being registered.

Person 3

Please provide the name of the third person being registered.

Person 4

Please provide the name of the third person being registered.

We need more information….

Name*

This person is the contact person for this registration and person #1 if multiple registrants.

First Last

Recognition Name

Please enter the name you want to use for recognition on the website. If you wish to be anonymous, type Anonymous.

Address*

Street Address City State ZIP Code

Company

If 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.

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.

Yes

No

Comments to RKC Express!

Show some team support! (It will be displayed on the website!)

Total

This is the total amount for your registration or donation. As you make additional choices your total may change.

Credit Card*

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

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