REGISTRATION FORM
PLEASE CHECK WHICH SITE YOU WILL BE WALKING
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18th Annual “Walk for Lupus Now”
September 25, 2005 – 10:00 a.m. M.D.C. Reservoir1420 Farmington Avenue (Rt. 4) West Hartford, CT |
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The First Annual New Haven “Walk for Lupus Now”
October 2, 2005 – 10:00 a.m. Light House Point Park 2 Light House Point Terrace New Haven, CT |
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ENCLOSED IS THE PLEDGE AMOUNT(S) |
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TOTAL AMOUNT ENCLOSED |
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I WON’T BE ABLE TO ATTEND THE WALK BUT WISH TO MAKE A CONTRIBUTION. |
$ |
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WAIVER I hereby waive all claims against the Lupus Foundation of America, Connecticut Chapter, Inc., their sponsors, vendors, West Hartford MDC/New Haven Light House Point Park from any injuries, losses, expenses, and damage, related to my participation in the Walk. Participants under the age of 18 must have the application signed by a parent and/or guardian.
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Participant’s Guardian Signature |
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