Walk For Life 99 Registration Form

 

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More WALK info...

If you'd like to walk, then please complete the following registration form. By pre-registering now, you save yourself time on Walk-day and help us get a jump on the huge amount of data entry that needs done for an event like the Walk for Life.
  • Please fill out all bold-face fields. Other fields are optional:

    •  
    First name
    Last name
    Street address
    PO box or apt. number
    City
    State/Province
    Zip/Postal code
    Country
    Home Phone
    Work Phone
    E-mail
    Web site URL
    Date of birth
Church or Organization affiliation:

Church location (city/state):

I am an/a:

    Adult
    Teen
    Child
How did you hear about the walk?:
    Church
    Mail
    Friend
    Web
    Parent
    Newspaper
    Other: 
Have you walked in the Harbor House WALK FOR LIFE before?:
Yes No
I release Harbor House Maternity Home Inc. from any liability for this event:
Yes No
After submitting this form, please use the BACK feature on your browser to return.

Last revised: March 29, 1999

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