Boston Prostate Cancer Walk 2009 Registration Form
(Please print this form and send to us with your donation)

  • YES! I am happy to participate and join prostate cancer survivors, their families, and their friends in the Boston Prostate Cancer Walk on Father's Day, June 21, 2009 on the Boston Common.

    Registration 9:00-11:00 AM     Pre walk Ceremony 11:00 AM     Walk at 11:30 AM
  • Enclosed is my registration fee of $20, which includes a Tote Bag which will be available on the day of the walk This year, to better promote our walk and awareness of prostate cancer, walkers will receive a canvas Boston Prostate Cancer Walk Tote Bag with our logo and sponsors names. Please wear your T-shirt from any of our previous walks.

    No. of walkers _____   Number of Tote Bags _____   Total enclosed $________
    Name:__________________________________________________________
    Address:________________________________________________________
    Name:__________________________________________________________
    Address:________________________________________________________
    Name:__________________________________________________________
    Address:________________________________________________________
    Name:__________________________________________________________
    Address:________________________________________________________
  • I wish to make a monthly pledge of $ ________ through December 2009.
  • I am unable to participate in the Boston Prostate Cancer Walk. Enclosed is my tax exempt contribution of $25_____ $50_____ $100_____ Other $_____ for prostate cancer research.


  • Boston Prostate Cancer Walk 2009 Individual Sponsorship Opportunities
    Deadline for names to be placed on our canvas Tote Bag is June 1, 2009

    $1000  Gold Sponsor-Individuals: Your name on Tote Bag, Walk Program & website.
    $500   Silver Sponsor-Individuals: Your name on Walk Program & website.
    $250   Bronze Sponsor-Individuals: Your name on Walk Program.
    *Names may be "In Honor Of" or "In Memory Of".


    Please make checks payable to:    Boston Prostate Cancer Walk
                                and mail to:           69 Farragut Avenue, Somerville, MA 02144

    For more info, please contact Stan Klein at 617-625-4875 or email: klein@rcn.com.

    Thank you for your support!.