23rd Annual Tomorrow Fund Stroll Early Bird Registration Form

Name*

First NameLast Name

Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

StrollingRollingDonation

Registration*

Team Member/Individual Participant

Please select the correct quantity of Strollers/Rollers. List Team Name and Team Members below. Individual participants please print your information below. No charge for children 10 and under.

$25.00

Size	Quantity
S
M
L
XL
XXL

Tomorrow Fund Family

A Tomorrow Fund Family includes past/present patient & immediate household members only. All other participants will follow normal registration fees listed. List Team Name and Team Members below. Individual Tomorrow Fund Family participants please list household family members below. Tomorrow Fund Families receive (2) T-shirts, one with the registration fee and one for the family.

$25.00 QuantitySizeFamily Shirt Size (free for TTF Family)

One Time Stroll Donation - enter a whole amount

$1.00 Donation Amount

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Tell us the name of every Stroller/Roller you are registering today (if they are under the age of 10 please indicate that below as well)*

Please specify the Patient's First and Last Name

Please specify the Full Name or Team you are supporting today. If you are not part of a Team please type N/A*

If applicable, please specify the Full Name or Team your one time donation is supporting . If you would prefer to make a donation In Memory/ In Honor, please list their name below.

RELEASE & WAIVER: By checking the box below, I acknowledge that my participation in The Tomorrow Fund Stroll is voluntary and may involve a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby fully release, remise, discharge and hold harmless The Tomorrow Fund, Garden City Center, Gateway Woodside, Inc. and their affiliates, officers, trustees, agents, representatives, successors and assigns together with every sponsor, organizer, and/or associated entity, individual or organization, whether individually or collectively, of and from any and all liability, for injury, death, or damages and/or any other claims, demands, losses or damages, incurred by me in connection with any aspect of The Tomorrow Fund Stroll at Garden City Center. *

Requests/Comments