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Registration Form
Walk to help assure a healthy birth day for all babies. Join the fight against birth defects and infant mortality by participating in WalkAmerica.
Yes, I am interested in walking, please send me a sponsor envelope
Yes, I want to know more about forming a WalkTeam
Volunteers to help with registration set-up, greetings are needed, too.
Yes, I want to volunteer to work on WalkAmerica Day.
Yes, I would like to serve on the Volunteer Committee.
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| Company Name | ____________________________________________ |
| Address | ____________________________________________ |
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| Phone# | ___________________Fax#_______________________ |
March of Dimes, 111 West Jackson, 22nd Floor
Chicago, IL 60604
Phone # 312-435-4007 or 1-800-431-WALK
Fax # 312-435-0988
Please print out this registration form and mail it to the address above.
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