WALK FOR CHILDREN Registration

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Please fill out and Submit Registration Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Team Name

Team Leader

First Name

Last Name

Team Category

Family/Friends

Business/Corporation

Club/Organization/Place of Worship

By clicking the "Sumit Form" button and submitting my information, I hereby waive all claims against PCAV for any injury I or my child might suffer in this event. I grant full permission for organizer to use photographs of me in legitimate accounts and promotions of this event.