Register to be a walker - Printable form available here *
Walker Name:

Walk start location: North Country Hospital to neighboring bike path for a distance of your choice.
Walk Date: Sunday, September 16, 2007
Start time: 1:00 pm

I am walking as:

Individual Team member
Team name:
Team Captain Name:

Tax deductible contributions will go towards diabetes education programs right here in our own community. Please fill out address so the hospital can acknowledge your gift.

Name Address Amount Received
 
Total:

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