Support our Power Walk event!

Thank you for supporting the Women's Resource Agency and our programs by registering for our Power Walk event. Using this payment option will register you for the event. Your name(s) will be kept at the registration desk/will call.

To register please use the following procedure:

  1. Select the type of registration (See Below)
  2. Type in the box the total amount to be paid
  3. Write in the Comments box the names of the attendees/individuals being registered

  • Power Walk Individual Registration - $20.00
  • Power Walk Student Registration (with valid ID) - $10.00
  • Power Walk Children Registration (up to two initial registrations, infants are free) - $5.00
  • Power Walk Children Registration (each additional registration) - $5.00
  • Power Walk Client Registration (MUST pre-register) - $5.00

This form should only be used to give a one-time gift registration. To make changes to an existing registration, contact us directly at (719) 471-3170 or e-mail us at

Please Complete All Information

Apply my Payment to:
Power Walk Individual Registration
- $20.00
Power Walk Student Registration - $10.00
Power Walk Child Initial Registration
- $5.00
Power Walk Child Additional Registration
- $5.00
Power Walk Client Pre-Registration
- $5.00

Total payment amount:   $0.00  (U.S. Currency)

Names of the attendees/individuals being registered:
500 characters left

Please Choose One of These Payment Options

 Credit Card & Check/Debit Card

Visa  Mastercard  Discover  American Express uses Entrust

 Bank Account Transfer (ACH)

Account NumberAccount Number
Account number
Routing NumberRouting Number
Routing number

* All payments made to Women's Resource Agency comply with U.S. laws and regulations.

Please Enter Your Contact Information Below
All fields marked with an " * " are required to complete your payment.

  (e.g. Mr., Mrs., Miss etc.)
  (e.g. II, III, IV, Jr., Sr. etc.)
  (Military Personnel - Enter FPO or APO)
  (Military Personnel - Select AE, AP or AA)

( ) -

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Women's Resource Agency
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