Joe & Maggie's 

Walk for MPS

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the National MPS Society presents:
Joe and Maggie's Walk for MPS
Oct 12, 2002

Registration Form: 

Name: ____________________________________________________ Home Phone: (    )__________
Address: ________________________________________________________________________________
City: _____________________________________________________ State/Prov: ___________________
Zip/Postal Code: ____________________ Country: _____________________
Daytime Phone: (     )____________________   Email Address: ______________________________________

Registration Fees # Attending Amount

$  15.00 Per Person (includes t-shirt while supplies last):

 _____ $__________

Total Registration Fee Enclosed:

 $__________

Additional donation to MPS (thank you!):

 $__________

Grand Total Enclosed:

 $__________

 

 

Make checks payable to National MPS Society and send to:


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