Miller’s Grant Mission Miles: Sponsor and Walker Registration Form

A person's legs and feet walking on a track.

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Miller’s Grant Mission Miles: Sponsor and Walker Registration Form

Complete the Sponsor and Walker Registration form with the following information.

Payment Information for Sponsorship, Raffle and Donation

Contact Name(Required)

First Last

Company Name

Company Name as You Wish it to Appear in Advertising

Email(Required)

Phone(Required)

Billing Address (Address where credit card statement is sent.)(Required)

Street Address City State ZIP Code

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Adult Walker Fee

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Number of Adults

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Kids Between Ages 10-18 Fee

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Number of Kids Between Ages 10-18

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Kids Under 10

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Number of Kids Under 10

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Family (up to 4 family members)

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Number of Families

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Adult Group (up to four adults)

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Number of Groups

Sponsorship Level

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Non-Golfer Banquet Ticket $50 Each

50/50 Raffle Tickets

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Mulligans

I am unable to sponsor or Miller's Grant's Mission Miles but want to help seniors in need. Please accept my tax-deductible gift.

Enter an amount in the box below.

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

*A portion of registration fees are not tax deductible.

Walker Registration

Walkers must be register. There is no cost to walk the event.

Walker 1: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

Walker 2: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

Walker 3: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

Walker 4: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

Walker 5: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

Walker 6: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

Walker 7: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

Walker 8: First Name

First

Last Name

Last

Age

T-shirt Size

Available for ages 10+. T-shirts are only available in adult sizes.

Phone

Home Address

Street Address City State ZIP Code

For more information, contact Karen McNamara at 410-696-6774 or kmcnamara@lsmmd.org.

Sponsor and walker contact information will not be sold or shared with third-party vendors.