PRC - Sample Walk Registration

Sample Walk for Life Registration Form

Feel free to fill out the following form to see how it works.

This form can be completely customized to fit your needs.

It can be configured to take payments though PayPal, Authorize.net and Stripe
and provide instructions for paying by check as shown here.

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Church/School/Group Affiliation

At which location will you participate in the walk? *

I am: *

Shirt Size needed: *

Have you ever walked in our Walk for Life before? *

I would like to volunteer at the Walk for Life

By submitting this form, I waive all claims for myself and my heirs against the Women's Care Center for any injury or illness which may result directly or indirectly from my participation. I also give this organization permission to use photographs of me taken at the Walk for Life and associated events in future event promotion.

(Initial Here) I have read and agree to this waiver. *

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