The 2nd Annual Sebastian's RunWalk for a Cure Registration Form

April 24, 2010

Mt Laurel, AL

Registration starts at 7:30 am.

 

Parent's Name(s):________________________________________________________________________________________________

Child's Name/Age:_____________________________    Child's Name/Age:__________________________________________________

Child's Name/Age:_____________________________    Child's Name/Age:__________________________________________________

Address:____________________________________    Zip:______________________________________________________________

Phone:______________________________________    Email address:_______________________________________________________

Registration Levels:

□ Kids $15.00 (3 years to 18 years)             □  Individuals   $25.00 (over 18 years)        □ Family of Four: $60.00 (plus$10 per extra individual)

 Kids Shirt Size (youth size)                                                                    Adult Shirt Size (Adult Size)

______S  _______ M   _______ L                                  _______S   ________ M   ________L   _______XL   ______XLL

 

Check  (enclosed)                Credit Card:     VISA        MasterCard            AMEX              Discover

Card Number: _____________________________________Exp Date:__________________________________________________________

 If you want  to mail your registration and payment - please send to:

Children’s Hospital of Alabama

Sebastian's RunWalk for a Cure

PO Box 36505

 Birmingham , Al 35236

I have include full payment via check. Make check payable to Children Hospital. Check Amount: $_________________

 

Thank you for your support of  The 2nd Annual Sebastian's RunWalk  for a Cure Benefiting Neuro-Oncology Research Program at Children's Hospital

If you have any question, please email sebastiansrunwalk@gmail.com or call    205-382-5430