TINA THOMPSON DANCE FITNESS

REGISTRATION FORM

Colitis  & Anxiety Awareness 5K Walk/Run May 21, 2017 @7am

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First Name:


Last Name:


Email:


Daytime Phone number:


Evening Phone number:


Registration Fee Each Participant $30.00:


Pledge Groups of 10 or More Participants $300:


* All participants must sign a liability waiver of release/consent by May 15, 2017 (DOCTORS APPROVAL) before activity begins:


Pledge only $20-$100-$500:



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