Register Now for 2011 Walkathon - Hiking for Alzheimer's Care

Melabev is on the Move!  Register now for exciting 2011 Walkathon.   Use the form below.  For itinerary and other details on the Walk, click here: Hiking for Alzheimer's Care!     

                       

                                          REGISTRATION FORM for 2011 MELABEV WALKATHON

 

 

Please copy and paste this form into an e-mail or a blank Word document.  Complete it and either submit by e-mail (melabev.walkathon@gmail.com) or print it and submit by fax (02-666-6087) or regular mail (Melabev, POB 3235, Jerusalem 91031) .  For technical support e-mail or call: 02-655-5826. 

 

 Personal Details: Please write clearly and complete one form for EACH participant.

REGISTRATION FEE:  $100 (non-refundable) per participant. Sponsorship / Donation Commitments* for the Full Walk (includes Moonlight Walk).     To Secure your place submit your registration by November 15 [  ] Individual Hiker: I would like to participate in the Full Walk and commit to raise a minimum of $1,500  [  ] Child (18 and under accompanied by an adult) $750;  [  ] Student/Soldier $1000   [  ] Couples: We would like to participate in the Full Walk and commit to raise a minimum of $2,500   Please find attached Full Walk Registration Fee ($100/₪360 per person) in the amount of__________            *At least 50% of  your sponsorship / donations should be received by Dec. 1. The balance is due by Dec. 31, 2011 -  send much earlier to secure 2011 tax receipt.

 

Moonlight Walk ONLY There is no Registration Fee for Moonlight Walk – Only these donations / sponsorships commitments:   ₪600 /Adult   ₪350/Child accompanied by Adult  Please find attached our Moonlight Walk donation / sponsorship in the amount of __________ Moonlight Walk donations / sponsorships should be in the Melabev office by Nov. 15.

 

Please send your checks to:    MELABEV, POB 3235, 91031 Jerusalem, Israel, or

 

      via Credit Card:  Visa ____  Isracard _____  Other ________________________

      Name on Card________________________Signature _____________________

      Card # _____________________________  Exp. Date_____________________

      ID/Passport # of Card Owner                                                                                   

 

Credit card registration payment possible on-line: click here or Fax: +972-2-6666087

 

Sponsorships/donations qualify for an Israeli charitable receipt (Sief 46).  For update on the American Committee for Melabev's new credit card donation possibilities, click here.  For full details on local and overseas charitable contributions see:  http://www.melabev.org/posts/49  or e-mail: melabev.walkathon@gmail.com .  

 

Please note:  Once payment is made you will receive a medical affirmation statement to sign and return to the Melabev office to complete the registration process.   

I want to join:

Full Walk:    [    ]  Easiest Hike     [     ]    More challenging Hike    [    ] Challenging Trek

Moonlight Walk:    [     ]   Gentle    [      ]  Moderate

                                My T-shirt size is

                           [    ] small     [      ] medium     [     ]  large     [     ] x-large   [      ] xx-large

Thank you for completing this form.

You can submit it via e-mail as an attachment to:  melabev.walkathon@gmail.com   or print and send it via regular mail to: MELABEV, P.O. Box 3235, Jerusalem 91031 Israel along with the registration payment.

You can also submit your registration fee and sponsorships/donations via our secure on-line donations form: In the space there marked "I want my contribution to benefit. . ." indicate it's for your registration, and/or to sponsor a Walker and name the Walker.

 

We look forward to your joining us!             The 2011 Walkathon Committee