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Mail in Registration Form Please fill out all fields for each participant you are registering today.  Once you have submitted this form, within 24 hours you will recieve a confirmaiton email.  Once you receive that email, print it out and mail it in with your check or money order to CancerFree KIDS.  If you do not wish to submit your informaiton online, you can fill out a mail in form and submit it with your payment.  Please note that if you fill out this form you cannot pay via credit card.  If you would like to register online and pay via credit card then please follow this link to our Active registration page. Please use the following codes as a guide to your registration fees: Registration Category - Description (Age) Price Team Participants Non-Team Participants: CTM - Child (2 & under) Free C - Child (2 & under) Free YTM - Youth (3-12) $15 Y - Youth (3-12) $15 TTM - Teen (13-17) $20 T - Teen (13-17) $25 TM - Adult (18+) $25 A - Adult (18+) $30 Participation Level Check all that apply for each person 5K - 5K Runner - 9am W - 1 Mile Walker 10am FF - Fun Festival 10am-2pm JJ - Junior Jog (3-12yrs) -11:30am

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					Participation Level Check ALL that apply
Name	Age	Gender	T-Shirt Size	Registration Fee	5K	Walk	FF	JJ
		Please Select Male Female	Please select one YXS - Youth 2-4 YS - Youth 6-8 YM - Youth 10-12 Adult S Adult M Adult L Adult XL No Shirt	please select one CTM YTM TTM TM C Y T A
		Please Select Male Female	Please select one YXS - Youth 2-4 YS - Youth 6-8 YM - Youth 10-12 Adult S Adult M Adult L Adult XL No Shirt	please select one CTM YTM TTM TM C Y T A
		Please Select Male Female	Please select one YXS - Youth 2-4 YS - Youth 6-8 YM - Youth 10-12 Adult S Adult M Adult L Adult XL No Shirt	please select one CTM YTM TTM TM C Y T A
		Please Select Male Female	Please select one YXS - Youth 2-4 YS - Youth 6-8 YM - Youth 10-12 Adult S Adult M Adult L Adult XL No Shirt	please select one CTM YTM TTM TM C Y T A
		Please Select Male Female	Please select one YXS - Youth 2-4 YS - Youth 6-8 YM - Youth 10-12 Adult S Adult M Adult L Adult XL No Shirt	please select one CTM YTM TTM TM C Y T A
		Please Select Male Female	Please select one YXS - Youth 2-4 YS - Youth 6-8 YM - Youth 10-12 Adult S Adult M Adult L Adult XL No Shirt	please select one CTM YTM TTM TM C Y T A
Street Address				City
State				Zip
Email Address		* required			Phone
		Team Name
All people (participant, vendors & volunteers) attending the 2012 Butterfly Walk, 5K and Fun Festival are required to sign an event day waiver.  In order to submit this form, you need to understand and agree to this waiver on behalf of all the names listed above.  The waiver is as follows:   xx I understand that participating in this event is potentially hazardous, and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur while I am traveling to or from the event, during the event, or while I am on the premises of the event. I also am aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I, for myself and my heirs and executors, hereby waive, release and forever discharge the event organizers, sponsors, promoters and each of their agents, representatives, successors and assigns, and all other persons associated with this event (the 5th Annual Butterfly Walk and Fun Festival), for my all liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise.  In addition, I grant full permission to any and all of the above parties to use any photographs, videotapes, motion pictures, website images, recordings or any other record of this event. Please enter your name here as a signature that you understand and agree to the event day waiver on behalf of yourself and all parties listed on this form.  * required
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