Register for Team Parkinson’s 2013

Thank you for your interest in joining Team Parkinson’s 2013. Please fill out and submit the form below to join and create your own personal fundraising page. As a reminder, to receive full Team benefits, each Team member commits to a minimum fundraising goal of $500.

The cornerstone of Team Parkinson’s is the Seattle-to-Portland Bicycle Classic (STP), but each Team member is free to participate or create an event or activity of their own and use the Team Parkinson’s platform to raise funds and awareness for Parkinson’s care in the Northwest. Be sure to indicate which event or activity you are undertaking in the “Name of the Event” box below.

If you have any questions or need assistance with registration, please contact Joseph DiChiaro at (206) 748-9481 or joseph@nwpf.org.

* Indicates a required field

Personal Information

* First Name:

* Last Name:

* Jersey or T-Shirt Size:

* Phone Number:

* Address 1:

Address 2:

* City:

* State:

* Country:

* Zip/Postal Code:

Account Access

* E-mail Address:

* Create Password:

* Confirm Password:

Stay Informed

Yes, add me to the Team Parkinson's and NWPF e-mail news.

Parkinson's Affiliation

* I am:

Name of the Event:

Create and customize your personal Team Parkinson's fundraising web page.

Name:

(as it appears on your fundraising page)

Tagline:

(200 characters or less)

Welcome Message

Upload an Image

(100 KB max; 350 pixels wide by 100 pixels tall max)

* Fundraising Goal:

($500 minimum req’d.; numbers only--no commas, decimal, or $)

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