Sign-Up Form

Connie Prekeges 5K Memorial Walk
for Kids `n Cancer - Saturday, September 27, 2008
10:30am - Greek Church - 1703 N. Washington

Sign Up Sheet - For for Credit Card users

NAME: PHONE:
ADDRESS:
CITY: STATE: ZIP:
From E-Mail Address:
T SHIRT SIZE Preference (S, M, L, XL, XXL):
AGE:

Extra Note:

Select this button only after paying by selecting the payment link below:

Please read the following statement:
Sign and mail in with your check, or charge by credit card.
By charging your credit card, you accept the waiver below.

In consideration of the acceptance of my entry, I do herby acknowledge that I assume all risks resulting there from, and I do hereby, for myself, my heirs, my executors and/or administrators, waive, release, and forever discharge any and all sponsors and organizers, their officers, agents and assigns, the race director and volunteers from any and all liability arising from illness, injuries, or damages I may suffer as a result of my participation in the Connie Prekeges memorial "just Go Take A walk I understand that traffic control on the course will be limited and that I must watch for vehicles at intersections and on the roadway. THIS ENTRY IS NON-TRANSFERABLE AND NONREFUNDABLE.

ENTRY FEE: $25.00

PAYMENT: Click here to charge fee to your credit card. using Paypal

Remember, you can collect pledges for your walk over the internet!
Copy and paste this link to your emails for easy access www.prekegesfoundation.org