MCCSN WALKATHON SURVIVOR FORM

2007 MCCSN WALKATHON SURVIVOR FORM

The 14th Annual walkathon hosted by the Multi County Cancer Support Network will be held on September 14-15, 2007 at the old Franklin County High School football stadium at 6:30 PM. Traditionally, the walkathon is kicked off with a survivor lap in which cancer patients and survivors walk the first lap singing "Amazing Grace".

If you are a cancer survivor and would like to participate in our walkathon, please complete the following information and return the form to Janet Torstenson, 994 Cline Ridge Road., Winchester, Tennessee 37388. Her number is 931.967.7294.

There is no fee to participate in the survivor lap, and each survivor will receive a complimentary T-shirt. If you are unable to walk around the track, we can arrange for a wheelchair. Please indicate on the form if you need a wheelchair.

The walkathon is our main fundraiser. The proceeds are used to assist cancer patients in our eight-county service area.

We hope you will be able to join us at our 14th annual walkathon.

Please complete the following information and return the form to Janet Torstenson:

Name:

Phone number:

Address:

City, State, Zip:

T-shirt size:
Small ____	Medium ____	Large ____	X Large ____	XX Large ____	XXX Large ____

Please check here if you need a wheelchair for the survivor lap. ____