* Indicates a required field.

Your Name (First, Last):*
Your Address:*
Your City, State:*
Your Country:*
Your Zip Code:*
Your E-mail address (optional):
Your Phone Number:*
Name of Person(s) You Are Sponsoring:
(if sponsoring more than one person, separate names with a comma) 		*
Please note that if you are sponsoring more than one person, your bid amount entered will be applied to each person you list in the sponsor form above.
I (we) are pledging the amount indicated in this box for every shot made out of 100:
(Please input your dollar and cents amounts in this manner, i.e. $1.25 or .50 cents) 		*
Although we hope the facts are obvious, please note that if you pledge $1.00 per freethrow shot made, and your person makes 65 out of 100 freethrows, you will be asked to donate $65 at the conclusion of this program.
How would you like to be contacted after the "Shoot-a-Thon"?phone
e-mail
either by phone or e-mail
Please list any questions, comments or concerns below:
*You must read the following section and check the box below for your registration to be authorized:

I understand that this a fundraising event and that I am pledging a specific amount of money per freethrow made out of 100 shots. Upon completion of the event I agree to donate the calculated total of funds determined by the amount of freethrows made by the person(s) I am sponsoring (indicated above), multiplied by the amount of money I have pledged per shot made out of 100. You may contact me for my total donation by the method I have listed above when the "Shoot-a-Thon" is concluded.

I have read and agree with the above statement *
Enter the code exactly as it is shown below: *