Registration

REGISTRATION

for KICK FOR KANCER

2005

August 10, 2005 from 9:30 a.m. -12:00 p.m.

Please use the following information to Register for the KICK FOR KANCER which is to be held on August 10, 2005 from 9:30 a.m. -12:00 p.m. at Bob Warke Memorial Field, Front & Lehigh Streets, Hokendauqua, PA; Rt 145 N. to Lehigh St. Turn right. Go to first stop light. Field on your left (www.hokeyaa.com)

Or you may contact us for additional information about this event or the Foundation in general.

Pediatric Cancer Foundation of the Lehigh Valley, Inc.

P.O. Box 42
Whitehall, PA 18052

e-mail:		kfork@cancersupportgroup.org
Nicole:		610 264 7026
Fax:		610 264 7026

Or use the form below to send us any questions, comments or requests you have.

Parent Name:
Email:
Address:
City:
State:
Phone:
E-Mail:
Number of Attendees
Name & Ages of Participants:

	Helping children with cancer and their families