Spencer Crawford Children’s Foundation, Inc.

9900 West Sample Road, Third Floor

Coral Springs, FL 33065

(877) 731-3452

www.spencercrawford.org

          Walkathon &

          Family Fun Day

         November 16, 2008

Name of Participant: ____________________________________________________

 

Street Address:  ________________________________________________________

 

City:  __________________________________ State: ________  Zip Code: __________________

 

Telephone Number: _____________________  Cell Number: ___________________________   

 

Email Address: _________________________________

 

 

        

Please make check or money order payable to

Spencer Crawford Children’s Foundation, Inc.

and mail to:

 

 

Mail-in registrations must be received by November 10, 2008.

Mail-In Registration Form

Spencer Crawford Children’s Foundation, Inc.

9900 West Sample Road, Third Floor

Coral Springs, FL 33065

(877) 731-3452

Registration Fee:

 

(     )  Adult or Child 12 years or older Walkathon ($20.00)

(     )  Child under 12 years of age Walkathon ($10.00)

(     )  Butterfly Release ($10.00)

 

T-shirt size:

 

Child:    (     ) XS 2-4                                 Adult:    (     ) S

             (     ) S 6-8                                                 (     ) M

             (     ) M 10-12                                            (     ) L

             (     ) L 14-16                                             (     ) XL

                                                                              (     ) XXL