2023 Vaccine Injury Walk Registration
Vaccine Injury Awareness Walk 2023
Saturday, October 7, 2023
Walk Hours: 11:30 AM – 4:00 PM
Hess-Hathaway Park
825 S Williams Lake Rd
Waterford, MI 48327
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Zip Code
*
Payment
In the event that the walk is cancelled due to inclement weather or any other extenuating circumstance, there will be no refunds.
Adult Registration includes free t-shirt if ordered by September 25
1 ($25)
2 ($50)
3 ($75)
4 ($100)
5 ($125)
6 ($150)
7 ($175)
8 ($200)
9 ($225)
10 ($250)
1 ($25)
2 ($50)
3 ($75)
4 ($100)
5 ($125)
6 ($150)
7 ($175)
8 ($200)
9 ($225)
10 ($250)
Amount
Free Child Registration
*
Please select one option.
N/A
1
2
3
4
5
6
Select Option
N/A
1
2
3
4
5
6
Child Registration with T-shirt
Select Option (0)
1 ($15)
2 ($30)
3 ($45)
4 ($60)
5 ($75)
6 ($90)
7 ($105)
8 ($120)
9 ($135)
10 ($150)
Select Option (0)
1 ($15)
2 ($30)
3 ($45)
4 ($60)
5 ($75)
6 ($90)
7 ($105)
8 ($120)
9 ($135)
10 ($150)
Amount
Please list the desired sizes for all t-shirts ordered (per paid adult and paid child only). Please note that we cannot provide a shirt if you register after September 25. If you do not want a t-shirt, check the box below.
Skip the t-shirts?
Please select all that apply.
Yes. Even though I'm eligible to receive a t-shirt, I'll pass.
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Expiration Date/CVC
Name on Card
Card Billing Address
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Submit
Description
Vaccine Injury Awareness Walk 2023
Saturday, October 7, 2023
Walk Hours: 11:30 AM – 4:00 PM
Hess-Hathaway Park
825 S Williams Lake Rd
Waterford, MI 48327
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