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Saturday, September 28, 2019
Next Step Resources Center
Registration: 8:30 AM • Walk Begins: 9:00 AM
First Name
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Last Name
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I am:
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Adult
Child
Street Address
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Address Line 2
City
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State
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Alabama
Alaska
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Florida
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Hawaii
Idaho
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Indiana
Iowa
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Louisiana
Maine
Maryland
Massachusetts
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New York
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Texas
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Phone Number
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Church/School Group Affiliation
Email Address
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I am unable to walk, but will make a donation.
Have you walked in a Walk For Life before?
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Yes
No
Shirt size needed
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Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Comments
WAIVER OF LIABILITY - By submitting this form, I waive all claims for myself and my heirs against Next Step Resources 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.
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I Agree
I Disagree
I have read and agree to this waiver.
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