60th Anniversary Walk Registration

Date: Saturday, July 27, 2024 (Rain or Shine)

Time: 5 PM (4 PM Registration)

Place: Brigantine Rams Football Field – 265 42nd Street

Adults: $20 per person

Teams of 5 or more: $15 per person

Students (age 11-18): $10 per student

(Each team member must submit a separate registration form)

Questions? Contact Katie (609-413-7412) or Mary (321-749-6749)

Email: marycranesjcf@gmail.com

Please complete the form below:

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Name

First

Last

Select Role

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Emergency Contact Name

Emergency Contact Phone

Cancer Survivor?

Cost Per Registrant

Adult - $20.00
Team of 5 or more - $15.00
Students (age 11-18) - $10.00

Team that you are walking with (must be over 5 people)

Non-Participation Donor 1

First

Last

Donation (Non-Participation Donor 1)

Minimum Price: $10.00

Non-Participation Donor 2

First

Last

Donation (Non-Participation Donor 2)

Minimum Price: $10.00

Non-Participation Donor 3

First

Last

Donation (Non-Participation Donor 3)

Minimum Price: $10.00

Total

$0.00

Signature (Signature of Parent if under 18)

Clear Signature

In consideration of this entry being accepted, I hereby for myself, heirs, executors, and administrators, waive and release any claims I may have against South Jersey Cancer Fund, the city of Brigantine, all Parties, Groups, Organizations, Volunteers, Sponsors and(or) any Representatives involved in this event for any and all injuries suffered by me in these events. I certify that I am in physical condition for this event.

Payment Information

60th Anniversary Walk Registration

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