Beach St‰oll - Treasure Coast Hospice

T R E A S U R I N G
L I F E
6th Annual
Beach St‰oll
Regist‰ation
Archie’s Seabreeze November 8, 2014
The 6th Annual Beach Stroll will begin at Archie’s Seabreeze at 401 South Ocean Drive, Fort Pierce. Strollers will walk a one
mile route. Archie’s will host a brunch following the stroll. Please complete this form to register for the stroll.
Personal Information
Name _________________________________________________________________________
Address________________________________________________________________________
City________________________
State____
Zip______________________________
Phone________________________
Email________________________
Emergency Contact________________________
Payment
The registration fee is $25 per walker. Children 5 and under are free. Please complete one form for each participant.
q
Check
q
Cash
Please make checks out to: Treasure Coast Hospice
T-Shirt Sizes (If registering before October 21)
q Small
q Medium
q Large
q X-Large
q 2XL
Note: All shirts are men’s sizes.
Waiver: I hereby assume any and all risks which might be associated with participating in the Beach Stroll. I further waive, release, discharge and covenant not to sue Treasure Coast Hospice or any of
their representatives for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child as a result of taking part in the event. I also authorize the use by Treasure Coast
Hospice of any photo, film or videotape taken of me or my minor child at the event for any purpose.
Signature ____________________________________________________
Date_________
Bring a photo of the loved one you are honoring to place on the memory wall.
Please remember to write your name and phone number on the back of the photo so we can return it to you.
For more information, contact Jan Novack at (772) 807-6430 or via email at [email protected]
Join our online community: www.tchospice.org s
Check in is at 8:30 a.m.

Strolling begins at 9 a.m.