2014 Breast Cancer Awareness Walk, Bloomington, Indiana

Please fill out this registration form and bring it with you to the walk:

Registration form

(This will open as a Word document.)

Or you can print it from here:

 

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 Bloomington's Breast Cancer Awareness Walk

PLEASE BRING THIS COMPLETED FORM TO THE WALK

Please Print:

Name: _________________________________________________ 

Street Address:___________________________________________

City: ________________________State:______ Zip:_____________

Email Address: ____________________(To be used only for reminder for next year)

WAIVER: In consideration of being permitted to participate in the Breast Cancer Awareness Walk, I hereby for myself, my heirs, and personal representatives assume any and all risks which might be associated with the event. I further waive, release, discharge, and covenant not to sue the sponsors, organizers, volunteers, the City of Bloomington and their representatives, or successors and assigns, for any and all injuries or damages of any kind whatsoever suffered as a result of taking part in the Breast Cancer Awareness Walk and any related activities. I also agree to the use of any photo, film or video tape of the event for any purpose.

Signature: _____________________________________________        IU Student? _______Yes  

Parents signature for children under 18 years old: __________________________________________________

 The Walk is FREE, but donations are gladly accepted! 

October 25, 2014 * City Hall * 8:30 a.m. Registration

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