National MS Society - Walk Event: Survey - Walk MS Material Request Form

Please enter a username and password that you can use when you return. You can use this password to update your information or receive personalized content.

*	Username: Required	5 to 60 characters
*	Password: Required	5 to 20 characters
*	Confirm Password: Required

Question - Not Required - Please select your walk site from the list below: North Penn High School, Lansdale, PA
Ridley Creek State Park, Media, PA
Valley Forge Area, Valley Forge, PA
Fairview Park, Easton, PA
Lenape Park, Sellersville, PA
Moorestown High School, Moorestown, NJ
Washington Lake Park, Washington Township, NJ
The Chester County Walk @ West Goshen Township Park, West Goshen, PA
West End Fair Grounds, Gilbert, PA
Philadelphia Museum of Art, Philadelphia, PA
Tyler State Park, Newtown, PA
Gring's Mill Recreation Area, Reading, PA
Rose Garden Pavilions, Allentown, PA
Eastern High School, Voorhees, NJ
Elmwood Park Zoo, Norristown, PA
Ocean City Board WALK, Ocean City, NJ
Parvin State Park, Vineland, NJ

Question - Not Required - Team Name:

Please select the materials that you would like sent to you. Items will ship the week of January 11, 2010.

Question - Not Required - # of Brochure Packs (25 brochures per pack):

Question - Not Required - # of Brochure Stands: (each can hold 25 brochures)

Question - Not Required - # of Posters:

Question - Not Required - # of Walk MS Pin-up Sneakers (250 per pack): Please specify if you're ordering in packs or in individual sneakers

Question - Not Required - # of Walk MS Join Me Pins:

*9.

Question - Required - Please tell us how you plan to use these materials. Please check all that apply.

	Distribute to friends/team members to promote Walk
	Use as a thank you for a donation given by someone
	Use them as a tool to raise funds for you and/or your team (ie: Dress Down Fridays-donate $5 and wear button)
	Other, (please explain in the comments section)

Cubicle flags and team posters can no longer be requested, but you can download and print them by visiting the Walk Team Page.

Questions? Call 1-800-883-WALK (9255)

10.

Question - Not Required - Comments:

(Maximum response 255 chars, approx. 5 rows of text)

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National MS Society Greater Delaware Valley Chapter
One Reed Street, Suite 200, Philadelphia, PA 19147 (215) 271-1500 walkms@pae.nmss.org.
© 2009 The National Multiple Sclerosis Society, All Rights Reserved.
All registration fees and donations for this event are nonrefundable.