2018 Miles for Moms 5K Volunteer Application Form
Contact the East Georgia Cancer Coalition for any questions at 706-542-6449 or at info@eastgeorgiacancer.org
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First Name *
Last Name *
Email *
Phone Number *
Street Address *
I would like to be contacted by: *
Will you be volunteering with a child? If so, what is his/her age? *
Are you a cancer survivor? If yes, please enter your cancer type in "Other". *
I am available to volunteer on May 5th, 2018 during the following times: *
Choose your preferred areas of interest: (Choose all that apply) *
What is your t-shirt size? *
Waiver: In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against officials and sponsors of the East Georgia Cancer Coalition for injury or illness, which may result directly or indirectly from my participation. I further affirm that I am in proper condition to participate in this event. I grant permission to the East Georgia Cancer Coalition to use my photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. Please type your name below if you agree. *
How did you hear about us? *
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