Start a team for your family, friends, business, or organization. As the team captain, you will coordinate your team and set a team fundraising goal to motivate your team members. The following will apply to all walkers:

First Name:*	Last Name:*
Email:*
User Name:*		Password:*
Please Note: Username Must Be At least 6 Characters Long
Address1:*
Address2:
City:*	Select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY      Zip:*
Phone:
Cell:
Personal fundraising goal:
10 or more years of Recovery? Join the Honor Guard! The Guard leads the walk and recognizes every person with 10 or more years of recovery. Honor Guard members wear a purple sash with their number of years in recovery.
Will you walk with the Honor Guard?			Select Yes No
If Yes, how many years of recovery?			Select 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
T-Shirt size:	Select M L XL 2XL
*getting a t-shirt requires raising a minimum of $50.00 per person*
Comments:
Team Name:	(Name of the family, business, organization, or service provider your team will be representing in the walk)
Team Member Goal: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Team Fundraising Goal: (We suggest $50 per walker)
I want my proceeds to support the following PRO-ACT activities Select All PRO-ACT activities Philadelphia Recovery Community Center PRO-ACT's Recovery Training Center Southern Bucks Recovery Community Center Women's Recovery Community Center Bucks County Chapter Chester County Chapter Delaware County Chapter Montgomery County Chapter Philadelphia Chapter
*I AGREE - *I AGREE - I, for myself, my heirs, and executors, in consideration of any participation in RECOVERY WALKS! 1.75 mile walk for recovery, hereafter called the event, hereby release and hold harmless PRO-ACT and The Council of Southeast Pennsylvania, Inc., and others connected with this event, including sponsors, cities, municipalities, employees, volunteers, or agents collectively called the event group, from any and all claims for damages or injuries which I may suffer in connection with the event. I hereby certify that I am in good condition and am able to walk in this event. Additionally, I will permit the use of my picture in broadcast, print, and other media. If you are under 18, a parent or guardian must agree to this waiver on your behalf. An adult must accompany children under 8 years of age.
* are required fields