Moe's Walk 2012	Registration Form
Last Name:___________________________________	First Name:___________________________________
Street___________________________________	City___________________________________
State                                                Zip______________	email:_____________________________________
Gender:                            Age______________________	Shirt Size (Circle):   S     M     L     XL     XXL     XXXL
	Shirts guaranteed to all walkers registered by Saturday May 21st, 2012.
Payment    $15 Prior to June 9	$17 June 9                      Kids (under 12) Free
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Sponsor	Signs
Individuals, Companies or Organizations	These will line the path of the walk.
Interested in Sponsor Signs.	$50 per sign        Amount Paid
Please mark if sign is same as last year                                       Last Year
Name on Sign
Name on Sign
Name on Sign
Name on Sign
Make Registration and/or Sign Checks Payable to:	Moe's Walk 127 West Elmview Ave. Lackawanna, NY  14218
Website:  www.moetaltyfranzwalk.org