Step 2 of 4 (Registration Form)

Miles for Maizie
Donation Only

Saturday, May 10, 2025 in Maquoketa, IA at Maquoketa YMCA

Please enter your registration information in the form below. When you are finished, click the "Proceed to Confirmation Page" button to continue. Required fields are marked with a *.

Personal Information

Please enter the requested information about you (or the person for whom you are registering). Be sure the contact details are correct so that we can provide important, registration-related information.

first name

last name

Address Information

address

postal code

city

Contact Information

email address

re-type email

T-shirt Selection

youth small

youth medium

youth large

small

medium

large

extra-large

double extra-large

Questions & Add ons

* Thank you for your generous donation!

Please enter amount

Payment Information

Please enter your billing information. The credit card type will be determined automatically. Your information will be processed over a secure, encrypted connection. Once you have finished registering, GetMeRegistered.com will not store your credit card details.

credit card number

Expiration

security code

Copy name, country, address, postal code, city, and state/province from above?

name on card

billing street address

billing postal code

billing city

Charges will appear as "PP*GetMeRegistered Events" on bank statement description. All registrations are final. There are no refunds or cancellations. Check this box to acknowledge before continuing.

Proceed to Confirmation Page

Miles for Maizie Donation Only