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Sign up for the Challenge Coin program

Please fill out the form below to sign up for the Challenge Coin program. You must complete payment at PayPal in order to sign up. None of this information will be shared, sold, or otherwise distributed to third parties.

SPONSOR INFORMATION

First Name *

Last Name *

Email Address *

Mailing Address *

City *

ZIP Code *

CHILD INFORMATION

First Name *

Last Name *

Mailing Address *

City *

ZIP Code *

Price: $159.95

Georgia Sales Tax$

Total Cost

* Required