P.O. Box 780      1331 N. Goerig Street      Suite C.      Woodland, Washington USA      1-360-225-4749

Walk for Life Registration

Your Name:
E-Mail:
Address:
City:
State:
Zip:
Phone: Subject:
Church or Group:
I release this organization from any liability for this event.

I am an/a:
Adult    Teen    Child

How did you hear about our Walkathon?
Church    Mail    Friend    Radio/TV    Newspaper    Other

Please double check your e-mail address before registering. If there's an
error in your e-mail address, you may not receive a response. Thanks!