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)

Amount

Free Child Registration

*

Please select one 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)

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.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

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

Please Fix the Following

Close