Name *

Name

First Name

Last Name

Email Address *

Address *

Address

Address 1

Address 2

City

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What is your challenge goal you hope to achieve?

Who is competing in the challenge? *

Individual

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This entry is permitted to be shared on Small Heroes Facebook, Instagram and any other social media platform. *

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The cost of participating in the challenge is $25. After you submit your form please click the link below to enter your payment information.

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Please send us any photos you wish to share at smallheroes@gmail.com