Radiothon Registration Thank you for becoming a CHAMPION for kids! We are excited to have you as a supporter and to make sure you are prepared for your day and that we recognize you appropriately, please fill out the information below: First Last Business Name* Business LogoMax. file size: 32 MB. Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best Phone to be Reached at:Shirt Size #1* S M L XL 2XL Shirt Size #2* S M L XL 2XL Will you be attending challenge hour interview times?* Yes No If yes, how many people will be attending the challenge hour? 1 person 2 people 3 people 4 people Facebook Page Link (Optional) Instagram Page (Optional) Twitter Page (Optional) Hashtags relevant to your Business or Brand (Optional)CAPTCHA
