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Wednesday, August 27, 2014

Entry Form is Ready

Participants can register on active.com or use a paper version and send it to me or to the Valley View Medical Center Cancer Center.  Here it is:

Breast Cancer Remembrance Walk/5K    Saturday October 4, 2014 @8:00 AM
$20.00 registration fee  _____    
5K _____    1 Mile Walk ______
Name ____________________________________________          Date of Birth______________
Address ___________________________________  Phone # _____________________
City  _________________________________              Zip  _______________________
Email _________________________________  
Unisex Small                                                                      Child    Medium
            Medium                                                                                Large                                       
            Large                                                                                      Extra Large
            X-Large
            XX-Large

Are you a breast cancer survivor?  Yes    No
Emergency Contact  _____________________  Phone #  _______________________________
Please return by September 27, 2014 to: Robyn Brown, 237 South 400 East, Cedar City, UT  84720

or Valley View Medical Center Cancer Center.

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