COPE Walk 2017 COPE Walk 2017 will be held on Sunday, September 24, 2017 at the Long Beach Boardwalk in Long Beach. Please fill out the information in the fields and press the "Submit" button. * = Required Field Contact Information Title Mr. Mrs. Miss Ms. Dr. First Name * Last Name * Address * City * State * Postal Code * Country Email * Retype Email * Phone * Sponsorship Information Sponsorships/sponsor signs can be made in memory of a child, sibling or loved one. Mile marker sponsor ($150) Clear Selection Registration Information Team Captain (if applicable): I plan to Walk in the COPE Walk I plan to bring family/friends to walk with me Please list names/ages below. Additional walkers that you plan to bring (family members, friends, etc) Name Age Name Age Name Age Name Age If you do not plan to walk, you can sponsor someone else who is walking in the event. Please list their name below Walker's Name: Donation Information Donation Amount $25 $50 $100 $250 $500 Other Amount Tribute Information This gift is in Please choose... Honor of Memory of Healing for Tribute Name: Would you like COPE to notify someone that this donation was made? * Yes No Notification Name Notification Email Notification Address Payment Information NOTE: All donations are tax deductible under our EIN #46-5391861. An acknowledgment letter will be sent to you via the mail. Total Amount * Card Type * Card Number * CVV2 * CVV2 Information Expiration Month * Expiration Year * Comments To volunteer, or for additional questions/remarks, please enter a comment below: Security Code Type the text shown in the box into the field below. All characters must be entered in UPPERCASE. Reset Powered by eTapestry.com.