When you participate in the Walk 4 CMT campaign, you fund patient programs and treatment research initiatives to better the lives of the the 2.8 million people living with CMT. Find a WALK 4 CMT Near You St. Louis CMTA Youth Outing Registration Form Parental Contact Information Parent's First Name: (required) Parent's Last Name: (required) Parent's Mailing Address: (required) City: (required) State: -- select state --AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming ZIP: (required) Parent's Email: (required) Parent's Mobile Phone: (required) Parent's Alternate Phone: Emergency Contact Phone: (required) Emergency Contact Name: (required) Will you be attending the St. Louis Patient/Family Conference? YesNo Will you be staying at the Marriott? YesNo CMT Youth Information Child's First Name: (required) Child's Last Name: (required) Child's Age: (required) -- select age --101112131415161718 Child's Gender: (required) -- select gender --MaleFemale Child's Email (if applicable): Child's Mobile Phone (if applicable): Health/Diet Information Does your child have CMT? (required) yesno Is your child able to stand without assistance? (required) yesno Is your child taking any medication that will need to be administered during the outing? (required) yesno If yes, please explain: Does your child have allergies? (required) yesno If yes, please explain: Will your child be bringing an epipen? yesno Any other medical/dietary information we need to know?