Application for Winner Regional Health Labor Day Run/Walk Cancer Funds

Application for Winner Regional Health Labor Day Run/Walk Cancer Funds

If application is approved you will receive up to $100 depending on current funds available. Please one application per person.
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a current Tripp, Todd, Gregory, or Mellette County Resident?*

YesNo
Funds Available: Please choose a cancer type*

Colon CancerProstate CancerGynecologic CancerKidney/Bladder Cancer
Please contact Monica Metzger with any questions at 605-842-7304 or monica.metzger@winnerregional.org

*If application is approved, you will receive up to $100 depending on current funds available. Please one application per person.
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