REGISTRATION
The Second Annual "Next Step" Walk-A-thon
September 22, 2007 At 8:00 a.m.
Georgia Wildlife Federation
11600 Hazelbrand Road, Covington, GA
The Next Step Organization is sponsoring its
Second Annual Walk-A-Thon to raise awareness about
recovery from substance abuse. A portion of the
funds raised by the Walk-A-Thon will be used to provide
Recovery Scholarships
to Rockdale Houses for Men and Women to help individuals unable to pay.
Name:_________________________________________________________________________________
Address:_______________________________________________________________________________
City:____________________________State:_______________________Zip:________________________
Birth date:_____________Age day of Walk-A-Thon:________Male:___________Female:______________
E-mail
Address:__________________________Telephone:____________________________________________
In addition to walking in the Walk-A-Thom, I would
like to addend the continental breakfast at 8:00 a.m. and
the Speaker's session at l:00 p.m. at Georgia
Wildlife Federation.
Please send your completed registration form along
with a $10.00 donation, payable to Moya Price or
Lisa Dillon, P.O. Box 1392, Conyers, GA
30012, or, bring your registration in person the day of the
Walk-A-Thon to: Georgia Wildlife Federation,
11600 Hazelbrand Road, Coving, GA.
On-line registration can be accomplished through
SEPTEMBER 15, 2007 at http://rockdalehouses.org/new_page_6.htm
Please indicate your tee shire sign _____M ______L
______XL ________XXL
Attached is a SPONSOR FORM to be used by you to
record donations being made by those people willing to
sponsor your walk to help raise awareness of
recovery. Keep this form to record all donations you will collect
and turn in a copy of your Sponsor Form the day of
the Walk-A-Thon. Be sure to keep a copy for your
personal use in collecting the pledges made by our
sponsors.
WAIVER: In consideration of my entry into
this Walk-A-Thon, I, for myself and anyone entitled to act on
my behalf, waive and hereby release any and all
claims for damages I may have against The Next Step,
Georgia Wildlife Federation, and any and all
sponsors and their representatives, and any participants for
any injuries I may suffer in connection with this
Walk-A-Thon. I hereby assume all risks associated with
this including high heat and/or humidity, all such
risks being known and appreciated by me, I hereby certify
that I am in good physical condition and have no
medical conditions which limit my ability to walk in this
Walk-A-Thon. FURTHER, I hereby grant all
permission to any and all foregoing to use my photo or video of
any kind of this event for any purpose.
Signature:__________________________________________________
Date:_________________________________
Signature of Parent if Under 18 years of
age:____________________________ Date:____________________________