Individual Registration

Please complete the following information:

First Name	Last Name
Address
City	State	Zip Code
Phone	Cell
E-mail	Would you like to receive group information and updates via email? Yes No
t-shirt size
How did you hear about the walk?	How many years have you participated?
Name of child(ren) you are walking in honor of and year of their death. (Name/year will be on the back of our t-shirts)
I have read the walk-a-thon waiver and release form. Yes Walk Waiver $5.00 Registration fee, per walker, to cover the cost of your t-shirt. Mail check or cash to: God's Tiny Angels Walk Registration P.O. Box 1082 Massillon, OH 44648 -OR- to pay online using PayPal, go to our "How to Contribute" page and click on the link!

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