This form should be completed by a representative of the athletic organization in which the child(ren) participates. If you are not a representative, please contact the child’s coach to get proper organizational contact information and provide them a link to this site to submit nominations. The organization representative should submit nominations from each team in their organization at one time.

• We want to reach as many needy children as possible
• We will not accept individual orders, groups of shoes will be shipped to one athletic program/organization location to take advantage of bulk shipping rates
• The need of an organization or child may be independently verified in order to maintain the integrity of the program

To nominate your team, please fill out following information:

* indicates required information

About Yourself

1. Name *
2. Title
3. Email Address *
4. Phone *

About Your Organization

1. Organization name *
2. Type of Organization (Youth Assoc/School) *
3. Cleat Type Keystone (Baseball) Landshark (Football)*
4. Address
5. Address 2
6. City
7. State Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Non-US Address North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
8. Zip

Tell us about your organization