Name (Last, First  Please Print)	Credit  &     Award	Credit Only $3.00	Free

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address                                                Group                         

 

City                                                      State             Zip                           

 

Phone (        )                           Email                                                                      

 

Walk: ____________________________________________

 

Date:  ____________________________________________

 

Fill out a separate form for each walk and mail forms to:

 

Placer Pacers

PO Box 142

Auburn, CA  95604