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Normal Moments, Inc
...helping parents of children with critical illnesses share more normal moments every day.
Events >> "Little Things" Walk >> Walker Registration
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Buy a Raffle Ticket
Little Things in Life Special Raffle Tickets

Click here to buy raffle tickets

1st prize: 40" Insignia Flat Screen LCD HDTV 1080 pixels
2nd prize: X-Box 360 Pro Console System
3rd prize: Sony Cyber Shot 12.1 Mega Pixel Digital Camera

*winner need not be present to win

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Walker Registration


While the official registration deadline has passed, we still welcome new registrations via the web and on-site the morning of the walk.  T-Shirts may not be available for registrants who did not register before September 9th, however you may elect to pay only a $10 registration fee to cover the cost of lunch instead of the $20 fee to cover both lunch and a shirt.  If you still want a shirt and they are available, you can purchase one at the event for the additional $10.

Please fill out and submit the following form to participate in"The Little Things in Life" walk.

If you prefer to mail your information to Normal Moments, please print this page, fill in all information, and send it to:

NormalMoments, Inc
c/o Tricia Fragen
1318 Baylor Ct
Naperville IL, 60565

or fax to: 630.637.0230


Walker Registration

First Name: Last Name:

Street Address:

City: State Zip Code:

Email Address:   Phone Number:

T-shirt size preferred:

Check for a Vegan Lunch:

Emergency Contact Information
Please include an emergency contact who will not be accompanying you on the walk.

First Name: Last Name:

Relationship to walker: Phone Number:


Registation Donation Choice
The $20 MUST be paid 2 weeks in advance.  The rest of the donation can be pre-paid or paid at registration.  If you are not using a credit card to pay the $20, you have to mail it in advance if you want a t-shirt.  The $20 is a non-taxable deduction.  Any additional deduction above and beyond the $20 is taxable.

Register on line:
Please select credit card type:

Enter your credit card Number:

Expiration Date:

Donation Amount in Whole Dollars:  


How did you hear about us?

All personal information you provide is confidential and will not be shared. Please view our Privacy Statement for complete information


Waiver
If you are 18 and over, you will need to accept the following terms by selecting Over 18 Waiver.

If you are under 18, you must have an adult responsible for you present at the check-in on September 19 to sign this waiver on your behalf.

I understand and agree that I am voluntarily participating in the Normal Moments Fund Raising Walk at my own risk and my own request. I am in good health without any medical & physical restrictions prohibiting me from participation. I will wear properly fitting footwear with good traction enabling me to walk safely on all surface and conditions. I will not need any special assistance. Should I have an accident during participation in the Fund Raising Walk, including pre and post walk activities, I accept full responsibility for any injury and agree to hold Normal Moments and its Walk sponsors, volunteers, and participants harmless for any and all costs related to the injury, loss of work, and release same from all liability thereto.  I also give permission for the free use of my name, picture, and voice for future promotional use to benefit Normal Moments.

Please select if you agree to the following terms and you are over 18 or if you are under 18 and agree to have an adult responsible for you sign this waiver at the walk check-in on September 19.


When you hit the submit button, this form will be submitted.

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Little Things Handouts
 TitleOwnerCategoryLast UpdatedSize (Kb) 
Walker Pledge Sheet Christina Ordonez 6/24/2009 389.28 Download
*Normal Moments is a 501(c)(3) not-for-profit, supportive service organization exclusively.  No medical diagnoses or treatments will be provide, encouraged, or recommended by any representative of Normal Moments.  If you feel that someone associated with our organization has attempted to provide medical recommendations, please call 630.888.8111 immediately.
 
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