Send registration to:  Building Life Foundations “Peace Walk 2012,” P.O. Box 1051, O’Fallon, MO. 63366 

Make checks payable to:  Building Life Foundations.  Mailed registrations must be postmarked no later than Sat, April 7th, 2012.

Name: ______________________________________            Phone: ___________________    

Address: ____________________________________            Age:_______   


E-mail address:______________________________________________________________             

T-Shirt cost $15.00, if you would like to pre-order your shirt please include $15.00 with your registration.

Color (Circle one)     Black    Royal Blue    Green    Grey    Pink    White

Size:   S   M   L   XL   XXL  Gender:     Male    Female

WAIVER OF LIABILITY:  I understand that Building Life Foundations, the City of University City and University City High School, their employees, and all others connected with this event are not liable for any injuries which I may suffer while taking part in this voluntary activity.  I hereby waive and release any and all rights and claims I may have against Building Life Foundations, sponsors, or any personnel for any injury I might suffer in this event or for loss or damage to my property.  I acknowledge and freely accept the risks inherent with the walk.  I attest that I am physically fit to walk a mile. 

Signature:__________________________________________________        Date:_______________     

(Parent or guardian if under the age of 18)

April 14th 2012

Peace walk registration


Pre-Registration Group Fee: $10.00

T-Shirt $15.00 @ Event

Registration @ Event $15.00