Registration Forms

Ok, I know that some of you are a little weary of on-line registration.  I have made up a paper registration form.  I will post it on here.  If you could get it to me by September 25, I would be so grateful!  I am also looking for sponsors.  If you would like to be a sponsor, please let me know ASAP.  We will put your business logo, or a logo of your choosing if you are a private donor.  Thank you so much!  The sponsors will help pay for the t-shirt printing.

Breast Cancer Remembrance Walk/5K    Saturday October 5, 2013 @8:00 AM

$20.00 registration fee  _____    

5K _____    1 Mile Walk ______

Name ____________________________________________          Date of Birth______________

Address ___________________________________  Phone # _____________________

City  _________________________________              Zip  _______________________

Email _________________________________  

Unisex Small                             

            Medium                                      

            Large                                            

            X-Large

            XX-Large

Are you a breast cancer survivor?  Yes    No

Emergency Contact  _____________________  Phone #  _______________________________

Please return by September 25, 2013 to: Robyn Brown, 237 South 400 East, Cedar City, UT  84720

or Valley View Medical Center,