Lyme Disease Awareness Walk Registration Form

September 13^th, 2008

Wells Beach, Maine

(Rain Date: September 20)

All proceeds to go to the Lyme Disease Association for there work with Lyme disease research and education.

Click here for a printable version of this form that you can mail in.

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Click here for a printable version of this form that you can mail in.

Registration fee: $15.00

You may use the PayPal donate button on the left to pay the registration fee or to make an additional donation.

If printing and mailing in your form, please include registration fee in form of cash, check, money order, visa or mastercard when returning your form.  We will send you a confirmation/receipt via e-mail or mail.

Any questions please contact:
Jessica Platanitis: jessplat10@hotmail.com / 207-251-0658

Thank you for your support!