Use this form to register for the walk and show the world that Muslims care about creating strong, healthy, and safe families. After submitting your registration, you will be redirected to PayPal to submit your donation:

First name:		Last name:
Address:
City/State/Zip:
Phone:		Email:
Donation:	$
Do you plan to participate in the CTM/Safeplace Walk?		YES  NO
Would you like to volunteer with CTM?		YES  NO
Do you want to join the CTM mailing list?		YES  NO
If you are participating in the walk, please provide a shirt size:		S  M  L  XL