ShelterCare's First Annual
Summit Challenge
Setting the pace to end homelessness
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ONLINE REGISTRATION
CLOSES AT NOON ON
FRIDAY, AUGUST 7TH.
First Name:
Last Name
Street
City
State
Zip
Email:
Pre registration fee : $20
Day of registration fee : $25
To pay via credit card, fill out the fields below. This secure form will be emailed to ShelterCare where your card
will be processed and a receipt of the transaction will be generated and returned to you. You may also contact
Lucy Vinis at ShelterCare by calling (541) 686-1262 with all relevant information ready.
Card Type :
Expiration Date :
16 digit Card Number :
To pay via check, cash, or money order, please print and mail this completed form to the following address :
ShelterCare
PO Box 23338
Eugene, OR 97402
To complete registering for Sheltercare's 1st Annual Summit
Challenge select the appropriate category below.
Running Division
Walking Division
Date of Birth (entered mm/dd/yyyy)
Gender
Male
Female
T Shirt Size S M L XL
