Teen Club Member – Chase The Victory

Chase The Victory Teen Club Membership Benefits:

Your story featured on our website
Eligible to receive a gift of sneakers from the Chase The Victory Kickback program
Invited to exclusive Teen Club Meetups and other special events & opportunities

Step 1 of 3

Name(Required)

First Last

Email(Required)

Phone(Required)

Recipient's Name(Required)

First Last

Recipients Age(Required)

Recipient Shoe Size(Required)

Men or Women's Shoes(Required)

Phone Number for the Parent of the recipient(Required)

Phone Number for the person nominating the recipient(Required)

Recipients Diagnosis(Required)

Hospital Where the Recipient is being treated(Required)

Recipients Home Address(Required)

Street Address Address Line 2 City State ZIP Code