Friday, February 27, 2015

Autism Walk Registration

Autism Walk Registration

Print the registration form below and return it to ASRC
Autism Awareness Walk 2016
Saturday April 16, 2016
Cole Park
Day of Registration 10:00 AM
Walk Begins: 10:45 AM


Registration Drop off Location
Autism Spectrum Resource Center
3440 S. Alameda
Corpus Christi TX 78411
For more information
Contact Bill Butler, LCSW (361)851-5111

Autism Awareness Walk
April 16, 2016 at Cole Park
Registration Form
Last Name____________________________________________
Address________________________________________________________________
Phone_______________ E-Mail____________________________________________
Company or Team Name__________________________________________________
Person you are walking for_________________________________________________
Walkers
Adult $25.00 ____              Child $10.00 ______          Total Walkers _________

T-Shirts
Adult- ___S, ___M, ___L, ___XL, ___XXL, ___XXXL
Youth- ___YS, ___YM, ___YL, ___YXL
T-Shirt size availability will be based on the order that registration forms are received

Method of Payment: ____Check, ____ Cash, ____ Money Order_____
Make checks payable to: The Autism Spectrum Resource Center
____ I cannot participate but will make a personal donation. Amount Enclosed: $________

DROP OFF OR MAIL TO:
Autism Spectrum Resource Center
3440 S. Alameda
Corpus Christi TX 78411
Contact Bill Butler, LCSW (361) 851-5111
All proceeds benefit Autism Spectrum Resource Center CC-a 501 (c) (3)
www.asrc-cc.org