Order Form - Just $8 to Join

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Patches for exercisers Order Form, Please Print (Ctrl P) and Mail to: 

            Patches for Exercisers

            P.O.Box 29192 

            Columbus, Ohio 43229 

Membership Form (PRINT CLEARLY) Must be age 21 and older to join. We recommend that you see your doctor before starting any exercise program. 

First Name: ___________________________________ 

Last Name: ___________________________________

Street Address: _______________________________________________________________________  

City: __________________________________________ State: ________________________________ 

Zip: __________ Ph:  1- ____-____-____ 

Email Address: ___________________________________ 

Circle One: What is your age bracket? (21-30) (31-40) (41-50) (51-60) (61-70) (71-80) (81-90) (91-100) 

Walking Patches: Circle one of the mile marker parches below. Just Joining? Circle the 25 mile patch. 

25 miles   50   75   100   250   500   750   1000   1250   1500   1750   2000   2250   2500   2750   3000 

3250   3500   3750   4000   4250   4500   4750   5000   5250   5500   5750   6000   6250   6500   6750  

1. Just joining? Circle the 25 mile marker above. Then enclose this form with a check or money order for $8.00 made out to “Patches for Exercisers” and mail to Patches for Exercisers, PO Box 29192, Columbus, Ohio 43229. The $8.00 includes administration cost for your annual membership. 
2. If you are ordering a patch at the 50 mile marker or above then enclose this form with a check or money order for $5.00 made out to “Patches for Exercisers” and mail to Patches for Exercisers, PO Box 29192, Columbus, Ohio 43229.  

All Continental US Patch orders are shipped by USPS. Allow 2-6 weeks for delivery. For orders outside of the Continental US contact us for the proper shipping cost.