The Community Park
Bridge Ave. & Beaver Dam Rd. Point Pleasant
Registration 8:00 A.M. at the Band Shell
Walk begins at 9:00 A.M.
REGISTRATION AND DONATION FORM
Entry Fees
Adults - $25.00
Children (Ages 7-17) - $15.00
Children 6yrs and under - Free
______________________________________________________
Please check one:
Registration_____ Donation Only _____ Registration and Donation ____
Total Amount Enclosed $________________
Name(s)________________________________________________
Address_________________________________________________
Telephone__________________________E-mail_________________

Registration:
______Adults x $25 = $_______       ______Children(7-17) x $15 = __
______Children (6 and under) FREE
TOTAL NUMBER OF PARTICIPANTS________
TOTAL REGISTRATION FEES_________
Shirt Sizes (Total Quantity)
Youth ____S____M____L      
Adult ____S____M____L____XL____XXL
Please make all checks payable to:  ABTA/DiStase Walk
Mail completed registration form and check to:
Stephanie Beckedorff
ABTA/DiStase Walk
2503 Honeysuckle Ln.
Point Pleasant, NJ 08742
For questions or additional information, please contact Stephanie
at (732) 701-1680 or stbeck727@yahoo.com