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2. Who are you registering for?

   1. Yourself
   2. A Group (School or Class, Community Group or Workplace Group, Etc.)
6. Individual's Name
8. Individual's Phone Number
10. Minutes Walked
14. Name of School, Class, Community Group or Workplace
15. Contact Person
17. Phone Number
19. Number of Participants
21. Total Number of Minutes Walked by the Whole Group
25. To receive a copy of your submission, please fill out your email address and submit.
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field