2011 Registration Form
First Name
Last Name
Address
City
State
Zip
Phone
All instructions are contained within these registration documents.
Teams must consist of at least one adult persons.
Cook Entry:
Name of Dish
Submit or Mail this registration form to: The Parklawn YMCA, 4340 N. 46th Street, Milwaukee, Wisconsin 53216, Phone number is 414-873-9622 - Fax number is 933-1656 or email to info@menwhocookwi.com.
Please send me additional membership information for:
Waiver& Release from Liability: I hereby absolve myself, my heirs, executor and administrators of any and all rights and claims of damages I may accrue against The Wisconsin Black Chamber of Commerce, Inc., and The Parklawn YMCA, the Milwaukee Fatherhood Collaborative, the City of Milwaukee, its officials; or any and all private homeowners; or any and all people in facilities connected with the Men Who Cook / Dads Who Cook event for any and all injuries suffered by me while participating in the Men Who Cook Event. (Note if entrant is under eighteen (18) years of age, a parent must sign the waiver, too.)
Full Name:
Signature
Date
Deadline for Registration is July 31, 2010.
