NINTH ANNUAL NURSES WALK

Saturday, October 14^TH@ 9am in Anderson

Pre-Event Registration Form due by October 7^th

Registration also available after September 30^thOnsite and Online

Complete One Form per Person

The registration fee for the Walk is $25.00. This includes a tee-shirt. Please specify size below.

If a sweatsirt is desired, the registration fee is $35.00. Please indicate size below.

Walk location you plan to attend: *

AnMed Health Womens and Childrens Hospital

Walker Information

Name *

Date of Birth *

Address *

City *

State *

Zip *

Phone *

Email Address *

Registration Type *

Individual

Team

Team Name

T-Shirt and Sweatshirt Order Form

T-Shirt Size ($25 donation minimum)

	Adult Small
	Adult Medium
	Adult Large
	Adult XL
	Adult XXL
	-

Sweatshirt Size ($35 donation minimum)

	Adult Small
	Adult Medium
	Adult Large
	Adult XL
	Adult XXL

Donation Information

Amount Submitted *

Payment may be made using PayPal.
If registering by mail, make checks payable to: SCNF/Nurses Walk
Mail Check with Registration Form to:
SCNF/Nurse Walk, P.O. Box 1678, Columbia, SC 29202 by September 30, 2017
To honor a nurse with your donation, please indicate their name below.

(Names will be announced at the Nurses Walk)

In honor of

In memory of

Be sure to download a “Pledge Form” and have your friends and family support you in this walk by making a donation. All donations should be brought to the walk site the day of the event. Walkers and teams will be recognized and awarded a plaque for both “Most walkers on a Team” and” Most Contributions Raised by a Team.”

Signature *

clear

Date: * +

By submitting this form online, I agree to waive and release any and all rights and claims for damages I may have against South Carolina Nurses Foundation, the City of Columbia, Wannamaker County Park and all organizers, volunteers and sponsors of SCNF Nurses Walk. I attest that I am physically fit for participation in this event and grant permission for organizers to use the photographs taken at the event in which I appear for reporting and promotional purposes. Walkers under 18 years old must have parental/guardian permission to participate.