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Puzzle Piece Foundation
Supporting Children with Autism Spectrum Disorder
About Us
About Us
About Autism
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Color Me Blue 2024 REGISTRATION
Color Me Blue 2023 Photos
Past Events
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Ways to Give
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About Us
About Us
About Autism
Events
Color Me Blue 2024 REGISTRATION
Color Me Blue 2023 Photos
Past Events
Grants
Ways to Give
Our Sponsors
Contact
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WORKSHEET
Number of adults registering on this form.
Adult registration is $20 per person. Please type the number of adults in the QUANTITY field.
Number of Adults Registering
Quantity
Price:
$20.00
Quantity
T-shirts and sizes
Each adult will receive one t-shirt. Please indicate sizes and quantities below.
Adult Small
Small
1
2
3
4
Adult Medium
Medium
1
2
3
4
Adult Large
Large
1
2
3
4
Adult X-Large
X-Large
1
2
3
4
Adult XX-Large
XX-Large
1
2
3
4
Adult registrants
Please enter the names of all adult registrants below, one name per line:
Number of children registering on this form.
Child registration is $10 per person. Please type the number of children in the QUANTITY field.
PLEASE NOTE:
Toddlers may participate for free, but will not receive a t-shirt. If a t-shirt is desired, please enter as a child.
Child participants
Quantity
Price:
$10.00
Quantity
T-shirts and sizes
Each child will receive one t-shirt. Please indicate sizes and quantities below.
Child small
Small
1
2
3
4
5
Child medium
Medium
1
2
3
4
5
Child large
Large
1
2
3
4
5
Child registrants
Please enter the names of all child registrants below, one name per line:
Toddler registrants
Please enter the names of all toddler registrants below, one name per line:
Questions or comments:
Comments
PAYMENT INFORMATION
Please enter the following for the person paying the registration fees. Your payment will be processed securely via Stripe, using your regular credit or debit card!
Name
First
Last
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Please provide a method of contact in case we need to reach you.
Email
Phone
CAPTCHA
Total
Total Due:
Credit Card
Phone
This field is for validation purposes and should be left unchanged.
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