Survey - Step Up to the Plate Registration - The ALS Association Indiana Chapter

Step Up to the Plate Registration

Please provide your contact information

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Name:

First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

Employer:

If you respond and have not already registered, you will receive periodic updates and communications from The ALS Association Indiana Chapter.

Yes, I would like to receive postal mail from The ALS Association Indiana Chapter

Keep me logged in. What's this?

Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	12 to 99 characters
*	Repeat Password: Required

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Question - Required - School/Organization Name

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Question - Required - Athletic Director, Principal, or other key contact (name and phone number)

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Question - Required - Team Name

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Question - Required - Team Colors

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Question - Required - Team Mascot

Question - Not Required - Proposed game date (or TBD)