2011 Walk for PKD Registration

Walk*	Guelph - September 10th 2011 Vankleek Hill – September 18th 2011 Toronto - September 25th 2011
First Name*
Last Name*
Email*
Address*
City*
Province*
Postal Code*
Phone*
Are you joining as individual walker or part of a team	Participate as an individual Participate as a team
Team name (fill in name)
Are you a Team Captain	No Yes
What size of T-shirt would you like?	Youth Small Youth Medium Small Medium Large X-Large XX-Large XXX-Large