Hike-A-Thon Registration Form

Thank you for joining cpp for its second annual Hike for Healing Hike-A-Thon. Currently the families of Preynheat Commune, Kampong Speu Province in Cambodia have no health care. Help CPP build a place of healing in Cambodia.  All donations and pledges will go directly to CPP's 2014 project HEALING A COMMUNITY.



Hiker Information
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Team Name:
(optional)
Phone:
Email:
T-Shirt Size: (Small / Medium / Large / Extra Large)
Comments:

Liability Waiver:

As a participant in CPP’s Hiking for Healing Hike-A-Thon, I agree to assume all risks of personal injury, death, or property loss that occurs as a participant. I certify that I am physically capable of participating in this event. I grant full permission to the organizers of this event to use and publish my name and image as a participant in all media. 



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