Strides for Change Registration

Thank you for participating in our 2018 Strides for Change Walk. This year marks the 14th anniversary of this event!

Please fill out this form to complete your registration. Once the form is completed you’ll be redirected to a page where you will be able to download the pledge form.

We’ll see you on June 9th at 9:00 a.m. at Springbank Gardens on Wonderland Road! There will be signage at the road to direct you.

Strides for Change Registration

Instructions Please complete the form and you will be forwarded to page where you'll be able to download the pledge form. MADD London Chapter P.O. Box 27066 London, ON N5X 3X5
First Name *
Last Name *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Email *
T-Shirt Order *
Please indicate if you would like to have a Strides for Change official T-shirt, or if you will not require one.Yes, please order me a T-shirtNo thanks, I am bringing my own
T-shirt Size
Please include your T-shirt size so we have one available for you.SmallMediumLargeExtra LargeXXL
In Memory/Honour of If you are walking in honour/memory of a loved one, please indicate that here.
Memory Cards As this is a memorial walk we like to remember those we've lost or who have been injured. If you have not already done so, if you would like, we can create a memory card for you to wear as you walk. Please upload a picture.
Memory Card Details
Please indicate your loved one's full name, date of birth and date of passing or injury. Also, how many cards you will be requiring.

Verification

Please enter the digits below *24
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