Attack ACC - Register

2^nd Annual 5 mile fun run/walk

Attack ACC Foundation

Adenoid Cystic Carcinoma

Moonwalk Raffles Face Painting Clowns Music Food

September 6, 2008 9:00 am start time for runners

Hickory Creek Junction 9:15 am start time for walkers

Rt. 30 (Lincoln Highway), 1 mile west of Wolf Rd.

Check in on day of walk starts at 8:00am

Registration

Please fill out your contact information below.

*First Name:

*Last Name:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*Home Phone:

Work Phone:

*Email:

*Participant:
Walker
Runner
Donator

*T-Shirt Size:

*Fee:
Child $10
Adult $20
Donate Any Amount

Registration Fee - children in strollers free
Adult (T-shirt not guaranteed) ....................................................................................................$20.00
Children/Students (High School/College)...................................................................$10.00

Waiver and Release

In consideration of receiving permission to participate in this 5 mile walk, the receipt of which is hereby acknowledged, I hereby forever discharge and release Attack ACC Foundation, Will Co. Dept. of Forestry, and the Village of Mokena, and all sponsors of this walk, as well as their employees, officers, volunteers and agents, of and from any liability, claims, demands and causes of action whatsoever; arising out of or related to any injury including death which may be sustained by me as a result of my participation in this walk. I further acknowledge that I am duly aware of the risks and hazards which may be associated with my participation in this walk, and I hereby elect voluntarily to participate and to assume all such risks and hazards. This waiver and release shall be binding on me, my heirs, next of kin and executors.

You may make your payment online below through our PayPal checkout or by mailing your check to:

Attack ACC Foundation
P.O. Box 3604
St. Charles, IL 60174-3604

Contact: Terry Almanza Killeen
773-750-7505

Moonwalk Raffles Face Painting Clowns Music Food