Kickathon 2022 | Champions4Cures

Your Name*

First Last

Your Phone*

Your Email*

Your Address*

Street Address Address Line 2 City State ZIP Code

Name of the kicker you are sponsoring*

First Last

Does the kicker want to participate in multiple events*

1,000 kicks, Forms Competition, Breaking Competition, Dragons Parkour

Which event does the kicker want to participate in?*

Which events does the kicker want to participate in?*

You may select multiple events.

Ticket Price

One Ticket*

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Option*

T-shirt Size for participant*

I would like to add a donation on top of the minimum ticket price

Your UMAC Location*

Total for Kickathon 2022

$0.00

Payment Information*

Card Details

Cardholder Name

Name

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Date: April 30th, 2022 Time: 9:30 AM Hosted at The Jefferson Valley Mall