Rollie Run Registration Form

Name:
Address:
City:
State: Zip:
Phone:
Age:
E-Mail:
Shirt Size:

Childrens: Small Medium Large
Adult: Small Medium Large
XL XXL
Payment Type:

PayPal Check
 

Paying by check? Please make payable to: "Rollie Run"
Submit this registration form and send or deliver to:

Mail to:
heartandsoul
PO BOX  787
Holland OH 43528

Deliver to:
Providence Lutheran Church or
Springfield Twp. Maintenance Building

Choose One:


Team Sponsorship:
A team of 5 or more can register for $15 per person. Please specify your team name and participants in the comments section below.

Comments:

By submitting this form, you agree to be charged the requested amount to the credit card specified. If you are paying a sponsorship by check, you are under a good faith agreement to bring the registration fee to the sign in table the morning of the run. We appreciate your generosity. And we thank you for participating in the Rollie Run! Questions?
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