SS LogoHelping EVERYONE touched by cancer live healthy and strong, using fitness – physical, nutritional and emotional – as the foundation for every day. 

Join the Surviving Strong Team at the UNITE Half
We are so excited that you have made the decision to particpate with us at the UNITE Half Marathon on April 17, 2011.  Together we will stand as a united force for the stregnth and possibilities for cancer survivors! 

Please complete the following on-line registration form for your participation.  Should you have any questions, do not hesitate to contact us at Susan@SurvivingStrong.org
Registration Form

First Name: *

Last Name: *

Address: *

City:*

State: *

Zip:*

Email Address: *

Home Phone: *

Mobile Phone:

Date of Birth (mm/dd/yyyy): *

Gender: *

 

I am a cancer survivor

Emergency Contact Name: *

Emergency Contact Number: *

Est. Race Finish Time: *

Shirt Size: *

 I have read and agree to the Surviving Strong UNITE participation agreement, including the minimal fundraising expectations.  To view agreement, click here.



Race Registration: 

I have already registered for the race directly through the Unite website, but wish to participate with the Surviving Strong team.

 I have not yet registered for the race itself, and ask Surviving Strong to register on my behalf.

I have read and agree to the UNITE Terms of Agreement.  To view agreement, click here.

Enter your initials here: *



Race Weekend: 

Do you plan on attending pre-race dinner? 

Yes

How many additional adult dinner tickets would you be interested in purchasing?:

 

Do you plan on staying at the same hotel as Surviving Strong?: 

Yes
 

Yes, I would like to be kept up to date about other Surviving Strong news and happenings!

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