Date: April 30th, 2022 Time: 9:30 AM Hosted at The Jefferson Valley Mall650 Lee Blvd Yorktown Heightsand Virtually on ZoomAll Proceeds Donated to Charity Download Kickathon Packet Purchase a Ticket Your Name* First Last Your Phone*Your Email* Your Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 ParkourYesNoWhich event does the kicker want to participate in?*1,000 kicks only (not championship)Forms CompetitionBreaking CompetitionDragons Parkour (4-6 year olds only)Which events does the kicker want to participate in?*You may select multiple events. 1,000 kicks only (not championship) Forms Competition Breaking Competition Dragons Parkour (4-6 year olds only) Ticket PriceOne Ticket*Ticket OnlyTicket and T-ShirtOption*TicketT-shirt Size for participant*- Please Select -SmallMediumLargeExtra LargeExtra Extra LargeI would like to add a donation on top of the minimum ticket price Your UMAC Location*- Please Select -ArdsleyBriarcliff ManorCarmelFishkillNewburghShrub OakLaGrangeTotal for Kickathon 2022 $0.00 Payment Information* Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.
