Registration - 2011 LET’S KICK CANCER WALK

Please enter your details below. (We will not share your information with anybody)

Name:
Email:	(eg: john@abc.com)
Address 1:
Address 2:
City
State:
Zipcode:
Phone:

I will walk as an individual ($15 registration fee)

I wish to sponsor other walkers too ($15 for each)

I will bring walkers under age Nine ( No charge!)


                            Please make the check payable to:

                                Let's Kick Cancer Walk / BCC and send it to the below address:
                            

                            Let’s Kick Cancer Walk 
                            

                            c/o Poorna Kemparajurs 
                            

                            1406 Somerhill Way 
                            

                            Anchorage, Kentucky-40223


                            I hereby waive, release and forever discharge any and all claims for damages and death, personal injury, loss of property or property damage I may have or that may hereafter  accure to me as an Event Participant. I discharge in advance the promoters, sponsors, volunteers and event aofficials.I understand that I must be in good health to particiapte, and I acknowledge that I am participating in the event at my own risk. I voluntarily agree the release and waiver.

                            
                            
	
                                    I agree