Register to Walk the Walk

* indicates a required field
Title*:
First Name*:
Last Name*:
Company Name:
Age:
Email Address*:
Address*:
Address Line 2:
City*:
State*: Zip/Postal Code*:
Country*:
Telephone*:
Cell Phone:
Alternate Phone:
Gender*: Male Female
Fundraising Goal*
We encourage you to collect donations from your colleagues, friends and family and now you can do it all online. Set your fundraising goal here so that they can help you reach your goal.
Other Amount:
(optional)
$
 
If joining a team, please select one:
If you wish to create your own Walkathon team, you will have the option to do so in your Walker Log-in.
 
Additional Adults:
If you are including other adults in your registration, enter their names here.
ENTER ONE NAME PER LINE.
 
Additional Contribution
You can take your first step in supporting Kidney and Urology Foundation. Start your fundraising by making a personal donation. Enter the amount here.
$
 
Will this donation be potentially matched?
If you know this information regarding the matching gift, please complete.
  Company Name:
  Matching Gift Amount: $
 
Your total will appear on the next page for confirmation.
Choose a Login*:
This will enable you to log in and edit your personal Walkathon page. It will also be your personal page's web address; i.e. nj.kidneywalkthewalk.org/username
Password*:
Confirm Password*:
Promo Code (if applicable):
Optional Text for your
Personal Page:
On your personal Walkathon page, you can write some optional text to encourage people to sponsor you, to note if you are walking in someone's honor, memory, etc. You will be able to change this text at any time.
 
Upload your own photo for your Personal Walk Page (optional)

(We recommend a maximum size of 150 x 215)

Or choose a photo from our Walk the Walk Photo Gallery:

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Check here if you would like to decline the offered fundraising prizes:

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