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General Information

Sex*

Male
Female
Have you participated in WNS before?*

Yes
No
Year*

Freshman
Sophomore
Junior
Senior
Graduate
Alumni
Faculty/Staff
Residence*

Team (Optional)

T-Shirt Size*

Small
Medium
Large
X-Large
Shift*

All 12 Hours
First 6 Hours
Last 6 Hours
No Preference
What is your goal to raise?*

$500
$1,000
$2,000
$5,000


Safety & Medical Information

Vegetarian*

Yes
No

I understand that I will be dancing for the amount of time that I specified above: *


Donation Information

Please submit the contact information of friends or family members. They will automatically be sent an email telling them about Wake 'N Shake and your participation in the event, and asking if they would be willing to support you by donating to the Brian Piccolo Cancer Research Fund on your behalf.
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