Lyme Disease Awareness Walk/Fun Run Registration Form

 

 Title:  Dr     Miss     Mr.     Mrs.     Ms 

 

Name:  

 

Mailing Address:       

 

Phone: 

 

E-mail: 

 

Age (optional): 

 

Registration fee: $10.00

Please include registration fee in form of cash, check or money order when returning your form. We will send you a confirmation/receipt via e-mail or mail upon request.

 

Send form and payment to: 

 Lyme Disease Awareness Walk C/O  Jessica Platanitis

236 Main Street #2

Saco, Maine 04072

 

Make all checks payable to Lyme Disease Awareness Walk

 

Any questions please contact:

Jessica Platanitis (207) 251-0658 or

 lymeawareness@gmail.com

 

Thank you for your support!