PREFERRED TEAM NAME:

TEAM NUMBER (DO NOT COMPLETE THIS SPACE: TO BE ASSIGNED BY MCCSN):

____

MCCSN WALK-A-THON TEAM FORM

The Multi-County Cancer Support Network is hosting the 14th annual Walk-A-Thon Friday, September 12, 2008 at Franklin County High School football stadium at 6:30 PM.  Proceeds will be used by the MCCSN to assist cancer patients and their families within the multi-county area.

WALK-A-THON RULES:

1. Cancer patients and survivors will walk the first lap.
2. Teams generally consist of 12 members; but may have up to 16 members.
3. Entry fee is $50 per team member.
4. A team member should be on the track at all times.
5. The last lap will be walked by team members present.
6. Only walking is allowed on the track during the walk-a-thon.  Bicycling, skating, and other
activities are restricted for safety reasons (strollers are OK!).

TEAM MEMBER  (PLEASE PRINT)

SHIRT SIZE (PLEASE CIRCLE)

PHONE NUMBER

1.

SM,  M,  L,  XL,  2XL,  3XL  

2.

SM,  M,  L,  XL,  2XL,  3XL  

3.

SM,  M,  L,  XL,  2XL,  3XL  

4.

SM,  M,  L,  XL,  2XL,  3XL  

5.

SM,  M,  L,  XL,  2XL,  3XL  

6.

SM,  M,  L,  XL,  2XL,  3XL  

7.

SM,  M,  L,  XL,  2XL,  3XL  

8.

SM,  M,  L,  XL,  2XL,  3XL  

9.

SM,  M,  L,  XL,  2XL,  3XL  

10.

SM,  M,  L,  XL,  2XL,  3XL  

11.

SM,  M,  L,  XL,  2XL,  3XL  

12.

SM,  M,  L,  XL,  2XL,  3XL  

13.

SM,  M,  L,  XL,  2XL,  3XL  

14.

SM,  M,  L,  XL,  2XL,  3XL  

15.

SM,  M,  L,  XL,  2XL,  3XL  

16.

SM,  M,  L,  XL,  2XL,  3XL  

If you would like to participate and do not have a team, submit an entry from with your name and fee to an MCCSN member and we will assign you a team.  For more information, call the MCCSN office at 931-393-4443 between the hours of 10:00 AM and 2:00 PM Monday through Friday.