American Cancer Society’s Relay For Life, Naples 2006

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American Cancer Society’s Relay For Life, Naples 2006 - Survivor Registration

In honor of your battle against cancer, we invite you to join us by walking the first lap of the Relay For Life. As a cancer survivor, your strength and courage are a testimony to the progress we are making in the fight against cancer. Please allow us to honor you and your caregiver, as we celebrate your survivorship!

Friday 6 pm: Opening ceremonies/Survivor Victory Lap Survivor reception immediately following
Saturday 10 am: Celebration of Caregivers

* = required fields

Your Name
*

Your Caregiver’s Name

Your Address
*

City
*

State
*

Zip
*

Day Phone
*

Work Phone

Email Address
*

T-shirt Size *

Date of Birth
*

Ethnicity
*

Type of Cancer
*

Date of Diagnosis: (M/Y)
*

Sex
*

Are you registered with The American Cancer Society’s Patient Services Center? *

If you are within three years of diagnosis, may our Patient Services Center call you with information? *

I plan to attend the following Relay For Life Location (s): *

Bonita Springs/Estero March 17-18, 2006

Golden Gate April 7-8, 2006

Marco Island April 14-15, 2006

Naples, Gulfview Middle School April 21- 22, 2006

Waiver: In consideration of being permitted to participate in Relay For Life, I hereby for myself, my heirs, and personal representative assume any and all risks which might be associated with the event, and I further waive, release discharge and covenant not to sue the American Cancer Society, its officers, members, sponsors, organizers or other representatives, or successors and assigns, for any injuries or damages of any kind whatsoever suffered as a result of taking part in the event and related activities.

Type Name Here
*

Date

Parent Name Here (if under 18)

Please check here if you would like to become involved with Relay For Life as a volunteer.

“From the moment of diagnosis through the balance of life, we celebrate your survivorship!”

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL- FREE, 1-800-435-7352, WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE

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Mrs. Landry - St. Louis, Missouri

We are coming to Naples to visit our grandparents. We were told that Fifth Avenue South, Tin City, Third Street South, Waterside Shops, and The Village on Venetian Bay, the hot spots for Naples Shopping, Restaurants and Naples Florida Hotels.
Tricia - Litchfield, Connecticut

We had no problem finding out about Naples Vacation Rentals or hotels, along with restaurants.
Samantha Stanton - Toronto, CA

We wanted to email your company to compliment you on the ExploreNaples.com website. Can you please write back to us with recommendations on which Hotels we should consider staying at, and which Naples Waterfront Restaurants have the best views?
Courtney & David Myers, Atlanta GA