breast cancer awareness relay for life...
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RELAY FOR LIFEZUMBATHON®
Date: Saturday, October 17, 2015 Place: Madison City Armory
Time: 7:00 PM – 9:30 PMRegistration Fee: $20 per person
Participant Name : ___________________________________________________________
Email:__________________________________________Phone:______________________
Address:____________________________________________________________________
Participant is under 18? YES NO Parent/Guardian Signature: ___________________________
Emergency Contact & Phone Number: __________________________________________________
Signature___________________________________________ Date _________________________
Mail completed registration form and check to:Janis Dailing, East River Electric, P.O. Box 227, Madison, SD 57042
Make checks payable to East River Energizers Relay Team
For more information contact Janis at (605) 256-8096 or [email protected]
Participants must read, date and sign to participate in the Zumbathon. I hereby certify that I am in normal health and capable of safely participating in the fitness event being held at the Madison City Armory. I understand that Zumba Fitness may be potentially dangerous and can result in injury, even under normal circumstances. I hold harmless the American Cancer Society, Madison City Armory, volunteers, Zumba Fitness Instructors and all involved in the Zumbathon fundraiser from liability for any harm that befalls me during my participation in this Zumbathon. I also understand that the registration fee is non-refundable. Furthermore, I offer my permission for the use any photographs taken of me during my participation in the Zumbathon for marketing purposes.
Benefiting the American Cancer Society Relay For Life of Lake County
Show further supportfor Relay for Life! Proceeds from snacks and beverages purchasedat the event will go to theAmerican Cancer Society.
Thank you for helping us finish the fight against cancer!
Great Music, Great Energy, Great Cause!
Make everymove count
Breast Cancer AwarenessSponsored by:
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First 75 to sign up receive a Zumbathon tote!