Walk-A-Thon Registration Form

A new registration form for the

May 2009 Walk-A-Thon will be posted

in the near future.

Please check

back soon!

Housing for the Homeless Walk-A-Thon Registration Form

Date: Saturday, May 30, 2009 ( Rain or Shine)

Registration Time: 8:00 a.m.

Start Time: 9:00 a.m.

Location: Mother’s Beach - Kennebunk, Maine

Length: Two miles

Raise $100 and receive a t-shirt.

Pre-register by April 30, 2008, to request your preferred size.

_________small __________med __________large_______ extra large

Raise $50 and receive a tote bag.

Bring a non-perishable food item and receive our gratitude.

Liability Waiver:

As a participant in the Housing for the Homeless Walk-A-Thon, I agree to assume all risks of personal injury, death, or property loss that occurs as a participant. I certify that I am physically capable of participating in this event. I grant full permission to the organizers of this event to use and publish my name and image as a participant in all media.

(Parent or guardian signs for walkers under 18 years of age)

_________________________________________________ Signature

_________________________________________________ Date

Registration/Contribution Form (please print clearly)

Name _________________________________________

Address _____________________________________________________________________________

Phone ________________________________ Email ____________________

Contributions (Please make checks payable to York County Shelter Programs, Inc.

P.O. Box 820 - Alfred, Maine 04002)

Names Pledge Amount Amount Collected

Kick things off with your own contribution! (Suggested donation of $25.00)

___________________________________________________________________________________

____________________________________________________________________________________

Total Collected