2019 Fox Cities Recovery Celebration and Memorial Walk

Complete one form for each participant

Register by August 23rd and the service fee of $1.50 will be waived! Late registrations (after August 23rd) are not guaranteed a t-shirt or memorial sign.

Participant

Adult / 18+ ($16.50)
Child / 17 & Under ($11.50)

Name

Phone Number

Address

Date of Birth

T-Shirt Size

Total

$0.00

T-Shirt: Recognizing those in Recovery

We would like to recognize those in recovery by including their name on the t-shirt. Complete the optional field below to recognize yourself or a loved one in recovery.

Name of Person in Recovery

Memorial Sign: Recognizing Loved Ones Lost

Loved ones who we have lost to addiction will be recognized on a Memorial Sign. Complete the fields below to recognize your lost loved ones.

Name of Lost Loved One

Date of Birth of Lost Loved One

Date of Death of Lost Loved One

Forever Age of Lost Loved One

Photo of Lost Loved One (<10MB)

Browse

Brief Story / Obituary of Lost Loved One

**NOTE** To submit additional names, please send an email to [email protected] detailing the information requested in the fields above.

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