Participant Registration

Please select a ticket option in order to continue the registration process.

Participant First Name:*

Participant Last Name:*

Participant Email:*

Confirm Email:*

By registering as a participant and providing your email address, you are agreeing to receive important participant event updates via email.

User Name:*

A user name and password must be entered in order to be able to access and update your personal fundraising page.
Enter a unique user name for each participant of the event. No spaces allowed.
(i.e. first and last name: janedoe or first initial and last name jdoe)

Password:*

Minimum 6 characters. At least one letter and one number.
Only enter letters, numbers, periods, hyphens or exclamation marks.

Confirm Password:*

I would like to set a goal of:*

CLICK BELOW TO SELECT A FUNDRAISING GOAL. You can participate and also setup a personal fundraising page to help raise extra funds to provide free peer support groups for those suffering the loss of a loved one.
This goal is not a commitment, but rather what Stephy's Place hopes you will be able to raise for our cause.

To make a donation in addition to your $50 registration fee, enter the additional amount in the "I would like to make a donation..." field below.

In addition to registering, I would like to make a donation in the amount of:

$.00

cancel registration