Racine Friendship Clubhouse Movin’ 4 Mental Health Team Roster
Team captain: Please complete and submit this form before May 12, 2017. (Individual registration
forms available online www.racineclubhouse.org)
Organization Name _____________________________________________________
Team Name ___________________________________________________________
Team Captain Name ____________________________________________________
Address ____________________________________________________
Phone _____________________ email ____________________________
PLEASE PRINT
Team Member Name
Phone
shirt
size
Registration
form
attached
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DISCOUNTED RATE FOR MINIMUM OF 10 PEOPLE $20 EACH
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Use separate form if you need to add members Prizes
awarded for Largest Team, Top Pledge Raising Team,
and Most Creative Team
Paid