It is our mission to increase local and national attention to the devastating impact that breast cancer has in the African American community.


To register, please provide the following information:
Name:
Address:
City:
State:
Zip:
Phone:
Email:
Gender: Male Female
Participated in 5K Walk: 2006: 2007: 2008:
Check One:

Child (under 11)

Teen 12 -19  

20 -29

30 - 40              

41-50            51-61  

Senior

   

Tee-shirt size: Child

S    M    L   

Tee-shirt size: Adult

S    M    L   
1X 2X 3X   4X
Advance registration fee (before 9/28) $23.00:

Additional Tax-deductible donation:

Total amount pledged:

Parent or Guardian submission required if under age 18

 


Race waiver and release: My requested signature below indicates I am a voluntary participant in this event and know this event is a potentially hazardous activity. I hereby assume full and complete responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event. I hereby release and hold harmless and covenant not to file suit against Sister Network of Central NJ® Inc. (SNCNJ) its local and national affiliates and affiliated individuals associated with this event. I hereby release them from any loss, liability or claims, I may have arising out participation in this event, including personal injury or damage suffered by me or other, whether same be caused by fall, contact with participants, conditions of the walk route, negligence of the host, the event site, or otherwise.  If I do not follow all rules of this event, I understand I may be removed from the walk. I give my full permission to SNCNJ to use any photographs, videotapes, audiotapes, and other recording of me that are made during the course of this event. This Waiver and Release will be stored electronically and I agree that a copy is authentic and admissible as evidence in any future dispute or proceeding.

Affiliate Chapter of
Sisters Network® Inc.
A National African American
Breast Cancer Survivorship Organization
Somerset, New Jersey 08873
Phone: 732-246-8300 - Fax: 732-246-3535

e-mail: sistercentral@sncnj.org

National Website: www.sistersnetworkinc.org

 

SNCNJ is a 501(c)3 non profit organization.
All charitable donations are appreciated.
Donations are also gratefully accepted
through United Way: ID #057318
and through the National Black United Fund: ID #7416
 



© Copyright 2009 Sister's Network of Central New Jersey. All Rights Reserved.