1
Transaction
2
Contact information
3
Payment
FR
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ataxia challenge participant registration
Transaction
Inscription adulte
$20.00
/ unit
x
$
=
Subtotal:
Total:
$
Don
$25
$50
$100
Subtotal:
Total:
$
Inscription enfant
$10.00
/ unit
x
$
=
Subtotal:
Total:
$
Total:
$
numéros du défi
Nom de la levée de fonds
Participant information
numeros de serie du participant
Participant name
Team information
serial number team
Team name
Next
Organization's registration number:
10760 0132 RR0001
Time remaining in your session:
15
Time remaining in your session:
15