If you have already registered, click here to sign in.

Fill out this form to register. When you're done, go to "Login" and create your own web page!
Please note that there is a $36 non-refundable tax-deductable registration fee. The registration fee goes towards your fundraising commitment.
Registration Information
First Name: *
Last Name: *
Address: *
City: *
State: *
Zip / Postal: *
Country: *
Phone Number: *
Additional Phone Number:
Email Address: *
Date of Birth: *
Jersey Size: *
Sweatshirt size *
Emergency Contact Information
Emergency Contact: *
Emergency Phone: *
Fundraising Commitment

Account Information
Custom URL:* Create your custom url to use for your personal fundraising page (This will also be your account username)
Sign in with Google or choose a password. You will need it to view / edit your personal web page, and see who has sponsored you for this event.
Sign in with Google
Password: *
Re-Type Password: *
Payment Details
You will be charged a $36 non-refundable registration fee.
Card Type: *
Card Number: *
Exp. Month: *
Exp. Year: *
Security Code: *
Additional Information optional
Additional Comments:
How Did You Hear About Us?
Waiver and Release

I accept the above waiver and release

Only enter this field if you were told to do so by a staff member.

Changing Lives-The Rabbi Ronnie Greenwald Scholarship Foundation