Part I-Revlon Run/Walk Registration:

Have you registered yet with Revlon Run/Walk this year?

  Choose one of the following Not yet. Yes, I will be participating as a member of The Wellness Community Team.

How did you hear about the Revlon Run/Walk?

  Choose one of the following Coffee Shop Dry Cleaners Friend/Relative Gym/Healthclub I've participated in previous years. Other Religious Organization Restaurant Sporting Goods Store The Wellness Community

The Wellness Community-West Los Angeles will be providing free round-trip bus transportation to and from the event. Space is limited and is available on a first-come, first-serve basis.  Be sure to include your email address if you plan to take our bus so that we can email you the departure time and instructions.

Do you plan to take the TWC-WLA bus to and from the Revlon Run Walk event? 

  Choose one of the following No, thank you. I will provide my own transportation. Yes, I would like to reserve a space on the TWC-WLA bus.

First Name:  

Last Name:  

Address:     

Address:   

City:            State:      Zip:

Send me information about other run/walk events   Please select an option Yes No

IMPORTANT CONTACT INFORMATION NEEDED FOR EVENT DAY:

Number of Cell Phone You Will Have With You on Run/Walk Day:  

Email:  

Emergency Contact Name:  

Emergency Contact Phone Number: