THE CAMDEN COUNTY ALZHEIMER’S WALK — REGISTER NOW! Please complete all registration information requested below. I am registering as* Team Member Team Captain Individual Walker Team Name:*Note: Please type Individual if you are not associated with a team Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Email* PhoneMy connection to the cause is:* I have been diagnosed with dementia I have lost someone to dementia I support or care for someone with dementia I support research for treatment and a cure T Shirt Size*If you donate $15 or more, you will receive a Walk t-shirt. It is one shirt per person per donation. Please provide your size below or select if you do not want one. S M L XL XXL I do not want a t-shirt Waiver/Release of Liability:* Waiver/Release of Liability: I hereby waive all claims against CCAP for any personnel injury I might suffer in this event. I attest that I am physically fit and prepared for this event. I grant full permission for organizers to use photos of me in legitimate accounts and promotions of this event. This iframe contains the logic required to handle Ajax powered Gravity Forms. Make your donation today! Donation in Honor Of… DONATE Donation in Memory Of… DONATE
