Walk at the Zoo

April 17, 2010

Registration Form***MUST BRING TO WALK-IN REGISTRATION LINE

 Registration and Doors open at 7:30 am.  Vendors open at 7:30 am.  Warm-Up at 8:20 am.  Opening Ceremony at 8:30 am.

ONLINE REGISTRATION IS CLOSED

 

We encourage all of you to strengthen your support by talking to friends, co-workers, and family about joining you on the walk or sponsoring you with a donation.

 

Walker:    Last Name, First Name                               Breast Cancer Survivor:         Yes     No   (circle one) 

 

Street Address                                                                        City/State                                                               Zip code

 

Email Address                                                                                                                        Daytime Phone

  

Late Registration Fees as of April 10, 2010

 

Adult                            ____ @  $ 35.00 each  (includes pin)                         _____

Adult                            ____ @  $ 55.00 each  (includes pin and t-shirt)       _____

Children 6 – 12             ____ @  $   7.00 each                                                 _____

Children 5 & under       ____ @  $   5.00 each                                                 _____

Additional donation                                                                                         _____

                                                                                                Total                _____

 

Adult t-shirt size:     Small       Medium          Large      X-large        1XL        2XL   

(circle one)

 

On Site Registration for Adults – $35.00 (includes pin); $55.00 (includes pin and t-shirt if any are still available)

                                       

Make check payable to the Shades of Pink Foundation

 

Method of Payment:       _________ Check           __________ Credit Card

Credit card information   _____­­­­_____Visa __________ Master Card

Billing address same as above? If not, enter billing address____________________________________

____________________________________________________________________________________

Credit card number__________________________________________

Name as it appears on the card________________________________

Expiration Date:______________             Security code (back of card)________________

 

***As of Wednesday, April 14, please bring completed form and check/credit card to Walk-In Registration Line at the Zoo.  We cannot accept mail-in registrations after that date due to mail delays. 

 

    Questions call: 248.551.8890 or email stridesofhope2010@comcast.net.

 

Please join us in helping women who are experiencing financial hardships resulting from their breast cancer diagnosis and related treatments.  

 

Shades of Pink Foundation is a 501(c)(3 ) public charity.