Registration Form 

Last Name 

First Name 

Home Address 

City,                            State                 Zip 

Phone                                                   Email



Are you a cancer survivor (circle one)       yes        no

 

Age _____ Fundraising Goal $________________

 

T-shirt size (Adult)  XS      SM      MD       LG        XL

 

 

Are you Joining or Creating a Team (circle one)

 

Team Name ___________________________________________________

 

Message  - This will be your welcome message.

___________________________________________________________

____________________________________________________________

___________________________________________________________

Thank you for registering your team. If you are a team captain, please contact debcost@optonline.net for a Team Captain welcome package. Or call 736-7473.

If you are joining a team, please contact your team captain for more information on fundraising and what to expect at this event.  Again, thank you for your support.


 

Cancer Never Sleeps…. and neither will we.  2008 Stay-Awake-A-Thon. Bringing our community together and supporting each other.