Walk For Autism

"Making big strides with small steps"
Saturday, April 9, 2011   12:00 noon
City Island and Riverfront Park
Harrisburg  PA

Registration Form

Pre-Registration is Required for all Walkers by March 26, 2011 to receive a T-Shirt

First name*

Address 1*

Address 2

City*

Phone

Email*

Number of Children accompanying walker:  

I will be walking as part of a team named:  

Team captain is:  

Free T-shirts to the first 500 pre-registered walkers.

Participant Fees: No Fee. Walk participants are encouraged to support the Autism Society by obtaining donations or making direct donations online.

DISCLAIMER:
I hereby waive all claims against the Autism Society -Greater Harrisburg Area Chapter, sponsors, or other personnel for any injury I and/or those under my direct care might suffer at this event. I attest that I am physically fit and prepared for this event. I grant full permission for the organizers to use photographs and quotes from me in legitimate accounts and promotions of this event.*

*Check if you agree to the terms in the above statement:   I agree

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