REGISTRATION FOR 2008 BUDDY WALK!

Join us on Saturday, Sept. 20
Registration begins at 10am, Festivities follow

Fees: $10 per adult, $5 per child. Shirts come in these sizes:
Adult: XL, L, M, S (XXL avail for $3 extra) and Child: L, M, S
Fees include t-shirt, speakers, music/dancing, lunch, goodies, and more!

 

All fields with ** below are required to register.

 

** Walkers Last Name
   

** Individual Walker First Names and T-shirt Sizes: Adult: XL, L, M, S (XXL avail for $3 extra) and Child: L, M, S

**

Desired Size

Desired Size

Desired Size

Desired Size

Desired Size

Additional Walkers’ Names/Sizes:
   

** Address

**City

**State

**Zip

** Phone

** Email

I cannot participate in the walk, but please accept my donation of
$

Please contact me to volunteer on the day of the event.

   

Waiver: In consideration of me and/or my minor child(s) being permitted to participate in this Buddy Walk,
I hereby, for myself, my heirs, and personal representatives, assume any and all risks which might be
associated with this event. I further waive, release, discharge, and covenant not myself and/or my minor
child(s) as a result of taking to sue NCDSN or the NDSS, it’s officers, employees, sponsors, organizers, or volunteers or other representatives or their successors and assigns, for any and all injuries or damages
of any kind whatsoever suffered by part in the events and any related activities. I also authorize the use by NCDSN or NDSS of any photo, film, or videotape taken of me and or my minor child at the event for an purpose.

PLEASE MAIL CHECKS TO: NCDSN, PO Box 456 Nehalem, OR. 97131
Call 503-368-6892 with any questions.
** By checking this box, you are agreeing to the above.