Registration Form for Walk for Life 08

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.

* Required fields

*Name
*Street address
*Street address
*City
*State/Province
*Zip/Postal code
*Country
*Home Phone
Work Phone
Fax
*E-mail
Web site URL
Date of birth
Gender:	Male Female

*Church or Organization affiliation (if none, enter "none"):

*Church or Organization 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

We will respond personally to your registration via email once it has been processed, which could take up to 72 hours. Please let us know if you do not receive a confirmation email. Thank you!