190 Welles Street . Suite 120 . Forty Fort, PA . 18704 . Phone: 570.714.8800
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Support Team
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Care Team

The Center for Cancer Wellness, Candy's Place would like to thank you for your support in this event.  Your support enables us to provide much needed care to our cancer patients and their loved ones.  It also helps us fund programs that meets the felt needs of our participants.

Last Year's Rainbow Walk was a great success.  Over 525 walkers gathered together to show their support towards our community services at Candy's Place.

Our 2010 Walk is scheduled for May 8th, 2010 at Kirby Park in Wilkes-Barre, Pa.  Only with your involvement will The Center for Cancer Wellness, Candy's Place be able to grow and serve more cancer patients and their families. 
All of our services are FREE for cancer patients.

Please fill out the form below to register for this year's Rainbow Walk on May 8th, 2010 at Kirby Park.
Registration begins at 9am and walk begins at 10am.

Distance: 2.5 mile fun walk!

Pre - Registration cost is $25.00 

Day of walk registration is $30.00

Thank you in advance from the Development Team!
 



First Name:   Last Name: 
Address: 
                  
Phone Number:  
Email:  
Shirt Size:  M   XL    XXL: (limited quantity)

List your Team Leader's Name:  (If applicable) 

PLEASE SIGN THE WAIVER:

As a condition of and consideration for my entry and participation in Candy's Rainbow Walk (the event), I,  intending to be legally bound, do hereby waive, release and discharge (on behalf of myself, my heirs and assigns, and my executors and administrators) any and all rights that I may now have, or that may hereafter accrue to me, to assert any demands, claims or causes of actions, of whatever nature or origin, against Candy's Place, Inc. or its agents or representatives; The City of Wilkes-Barre or its employees, agents or representatives and any and all sponsors or promoters of the Event, including but not limited to any demands, claims or causes of action related to any injuries suffered by me while participating in or traveling to or from the Event.

Initials: 
(Will represent your signature)
    
Date:       
Pay by Credit Card:     Pay by Check:

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