BURLESON PREGNANCY AID CENTER
WALK FOR LIFE ONLINE REGISTRATION

YES, I Want WALK on Saturday, April 5, 2008 at 9:00 a.m.
(Walk Registration begins at 9:00   *   Walk begins at 9:30)

(We are asking that all walkers pre-register,
 in order to help us plan effectively for the number of walkers we expect at each site.)

Name:
Address:
City:  State: Zip:
E-Mail:
Phone Number:
Church or Group:
What is your personal fund raising goal?   (Click here to read about our Lifesaver Club!)
Age/Group:
Please check all that apply: Contact me about opportunities to be a WALK volunteer.
  I can't participate this year but you may count on a donation from me in the amount of
I will      
I will walk on my own and will send or fax my completed sponsor sheet to the Burleson Pregnancy Aid Center.
   
Additional Comments:

By pressing the "SUBMIT" button below I certify that I am authorized to represent the applicant and that all information provided is true and correct.   I also acknowledge and release the Burleson Pregnancy Aid Center from any liability for this event.