2012 REGISTRATION FORM MAIL-IN REGISTRATION FORM REGISTRATION INFORMATION: MAKE CHECKS PAYABLE TO: Saturday, Sept. 29th 2012 Participant Name Company Name (If applicable) Street/P.O. Box City State Zip Cell Phone Home Phone E- Mail Address Sickle Cell Disease (SCD) affects an estimated 90,000 to 100,000 Americans. About 2 million Americans, or 1 in 12 African Ameri- cans, carry the sickle cell trait. Join us as we walk to raise awareness about SCD. The community is invited to enjoy FREE food, drinks, entertainment, and information on Sickle Cell Disease & Trait. It’s time we walk the walk! I hereby for myself, my heirs, executors, administrators, waive and release any and all rights and claims for damages I may have against the City of Gainesville, Sickle Disease Association of NCF, all co-sponsors, contributors and their agents for any injuries suffered by me during this event. I attest and verify that I am physically fit to compete in this event. & The walk will start at Citizens Field on NE Waldo Road, crossing University Avenue down to SE 11th Ave, passing Lincoln Middle School making a right on SE 15th Street to McPherson Recreational Complex. 9a.m.-1p.m. For more information contact Merv Sheppard: REGISTRATION FEE: $10.00 Registration starts @ 8 a.m. at Citizens Field All registrants will receive a FREE event T-shirt Race day registration will be accepted P: 352-591-4703 E: [email protected] Send your Mail-In Registration Forms to the following address w/$10 fee or register day of race. Sickle Cell Disease Association of NCF Sickle Cell Disease Association NCF P.O. Box 1262 Gainesville, FL 32602 ( ) ( ) @ Signature (All Registrants Must Sign) Date Parent Signature (If Participant is Under 18 Only) Age: ________ Race/Ethnicity: ____________________________ Shirt Size: SM M L XL 2X Please select your interests: to volunteer to become a SCDA member to become an annual SCDA contributor Please complete entire form. We will see you September 29th! 2nd

2nd Annual Sickle Cell Awareness 2k Walk | Mail-in Registration form

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Sickle Cell Disease (SCD) affects an estimated 90,000 to 100,000 Americans. About 2 million Americans, or 1 in 12 African Americans, carry the sickle cell trait. Join us as we walk to raise awareness about SCD. The community is invited to enjoy FREE food, drinks, entertainment, and information on Sickle Cell Disease & Trait. Register today!

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2 0 1 2 R E G I S T R A T I O N F O R M

M A I L - I N R E G I S T R A T I O N F O R M

R E G I S T R A T I O N I N F O R M A T I O N :

M A K E C H E C K S P A Y A B L E T O :

Saturday, Sept. 29th 2012

Participant Name Company Name (If applicable)

Street/P.O. Box City State Zip

Cell Phone Home Phone E-Mail Address

Sickle Cell Disease (SCD) a�ects an estimated 90,000 to 100,000

Americans. About 2 million Americans, or 1 in 12 African Ameri-

cans, carry the sickle cell trait. Join us as we walk to raise awareness

about SCD. The community is invited to enjoy FREE food, drinks,

entertainment, and information on Sickle Cell Disease & Trait.

It’s time we walk the walk!

I hereby for myself, my heirs, executors, administrators, waive and release any and all rights and claims for damages I may have against the City of Gainesville, Sickle Disease Association of NCF, all co-sponsors, contributors and their agents for any injuries su�ered by me during this event. I attest and verify that I am physically �t to compete in this event.

The walk will start at Citizens Field on NE

Waldo Road, crossing University Avenue

down to SE 11th Ave, passing Lincoln Middle

School making a right on SE 15th Street to

McPherson Recreational Complex.

9a.m.-1p.m.

For more information contact Merv Sheppard:

REGISTRATION FEE: $10.00Registration starts @ 8 a.m. at Citizens Field

All registrants will receive aFREE event T-shirt

Race day registration will be accepted

P: 352-591-4703 E: [email protected]

Send your Mail-In Registration Forms to the following address w/$10 fee or register day of race.