Event Registration

Please fill out the form below to join us in supporting Kids Chance of Rhode Island at our Track 15 PVD fundraiser.

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Name(Required)

First Last

Company

Contact Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Are you willing to provide a raffle item for the event?

Yes

Registration

Price:

Payment Type

Pay by Check

Pay by Credit Card

Total

Check should be sent to:
Kids’ Chance of Rhode Island
260 W. Exchange Street, Suite 101, Providence, RI 02903

Credit Card(Required)

Card #, Expiration MM/YY, CVC code

Enter your name as it appears on your card