Walkathon Registration Form

Registration starts at 09.00 AM
Sunday, September 08, 2019 - 10.00 AM

Venue: ERINDALE PARK, Mississauga ,
Areas C & D
( Mississauga Road & Dundas Street W)

Entry Fee : Ages 13 and above : $20
Below 13 : $10; Toddlers : Free

Special Offer : For those who participate in both events, we will have free food coupons for you at the walkathon

(Handi-Care Intl. will issue receipts)

Name :
Address :
City,Province :
Postal code :
Phone :
Email Address :
Donation Options :
Purchase Raffle Tickets Online : (Raffle Prizes List)
Select ticket
(The draw will take place on Sept. 8th at the Walkathon and you will be notified)
: $20-1tkt
Walkathon - Registrant / Pledger
: ( "Yes"- Registrant / "No"- Pledger)
 
No. of Registrant : No. of Adults:     No. of children:
If Pledging - Who are you Pledging for ? :
Total Amount (Raffle, Registrant, Pledge) : $
Comment :
Can your name be published on our website? :
Registration List
NAME Sponsor Registrant Walkathon Amount No. of Adults No. of Children
 Subha Varadarajan   Yes 60 2 2
 Aliya Satani   50  
 Vijay Bajaj   Yes 100 2 
 Gaibrie Stephen  Yes 25 1 
 Andrei Smarandache  Yes 50 2 1
 Shyam Baskaran   Yes 40 2 
 Shyam Shankar & Gwen Hughes   Yes 160 2 2
 Sandra Impey   60  
 Ryan Liebscher   300  
 Michelle White   100  
 Rishi Bajaj  Yes 100 2 
 Marlee Klaiman  Yes 20 1 
 Guruprasad Desai   40 2 
 Kousha Azimi   50  
 Mathu Baskaran   41  
 Neil Dattani  Yes 50 1 
 Karim Jessa   50  
 David Kepecs   20  
 Nikolaos Mamalias   110  
 K Badra   100  
 Arun Chockalingam   Yes 40 2 
 Stephanie Seilman  Yes 20.00 1 
 Christian Medved   100  
 Zahra Kanji  Yes 20.00 1 
 Zainab Najarali  Yes 20 1 
 Janna MacLachlan  Yes 50 1 
 Angelica Ng   200  
 Physio Connect - Advert Yes    
 Prakash Bansod  Yes 50 1 1
 Foundation Physio- Advert Yes    
 VMS Travel- Advert Yes    
 Kannan Dental- Advert Yes    
 Team Works- Advert Yes    
 Sanskriti- Advert Yes Yes  2 
 Shankar Vilanur- Advert Yes    
 All About Kids- Advert Yes    
 Alex Ghani- Advert Yes    
 Amit Saini - Advertisement Yes    
 MD Management- Advert Yes    
 CIBC Woodgundy- Advert Yes    
 Sandra Rao  Yes 20 1 
 Parthiban Elangovan  Yes 40 2 1
 Jaikumar Chinnakonda  Yes 80 4 
 Dinesh Krishna  Yes 2000 2 2
 Sulo Krishnamurthy  Yes 1000 1 
      
   Total 5166 36 9