Register

STEP ONE: Provide your information

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip:

Email:

Phone:

Daughter's
Name:

Daughter's
Birthdate:

(Note: If you are joining to support a girl who is not your daughter, please
enter her name here so we know who you are sponsoring.)

STEP TWO: Select your materials (check boxes)

Personalized Web Page: (see examples)
email the following to mygirlweb@girlpower2cure.org:
- up to 5 photos
- minimum 150 words about your daughter and family
- where you would like to link your page, ie your blog site

Personalized Girl Power Cards
email a photo for your daughter’s card to mygirlcard@girlpower2cure.org

STEP THREE: Select your opportunities

Dress Up 2 Cure Team:
Check this box if you would like to have a Dress Up 2 Cure Team for 2010.

Girl Power Network Privileges:
Check this box if you would like to be included in the Girl Power 2 Cure “inner
circle” by receiving our newsletter and having the opportunity to receive free
gifts from companies!

STEP FOUR: Submit registration form and proceed to payment page.
You will be contacted soon regarding your registration to make
sure you get off to a great start!

Questions?
Contact Kelly Butler, Program Director:
kelly@girlpower2cure.org
tel: 260.868.4802

For only $5/month you get access to all of the Girl Power 2 Cure opportunities and
materials! You may choose to have $5 charged each month automatically or pay a year in
full. We will not use this registration information for any other purpose without your
permission.

Use this form to register online with a credit card only!

To register by mail: print this form and include with payment* to:
Girl Power 2 Cure, Inc.
2891 Breakers Court
Amelia Island, FL 32034

*If paying with check by mail, include a check for $60. This is a one-year membership. If you would like to
pay $5/month, you will need to register online here with a credit card. Thank you!