Please submit a registration form for each participant. Once you have completed registration, you may submit your fees online or see the bottom of this page for instructions for mailing a check or money order.

Your Name (required)


Team Name (if applicable)

Address (required)

Home Phone (required)

Cell Phone

Your Email (required)

T-shirt Size


Check this box to indicate you have read & agree with the release above

Early Registration fees: until 4/06/18

Adults (18 and over): $20.00

Children (age 6- 17): $10.00

(Under 5 years – free)

Registration fees: after 4/06/18

Adults (18 and over): $25.00

Children (age 6- 17): $15.00

Registration fee includes T-Shirt

You may pay online or by mailing a check. Please make all checks and money orders payable to “Autism Awareness Walk 2018” and mail to the following address:

Nassan’s Place, Inc.,
P O Box 833
East Orange, NJ 07019

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