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Support Walk & Volunteer Registration


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Personalization

* denotes required field

Name*
Address*
City / State / Zip*
Phone*
Email
T-shirt (While supplies last. Size guaranteed by 1/25/2015)*
Days available to work
Restricitions
Committee Preferences
Walk Only*
Walk and Volunteer*
Event*
Name - In Honor of
Name - In Memory of
How did you hear about the event?*
By submitting this registration form & payment, I understand & agree to the participation of the 2016 Support Walk. PRINT FULL NAME *
tax free

8:00 AM Registration
Free goody bag
Free t-shirt (While supplies last. Size guaranteed if registered by 1/25/2016)
Trophies for 1st, 2nd, 3rd place teams with the most walkers
Trophies for 1st, 2nd, 3rd place for best decorated golf cart

By printing your full name and submitting this registration form and payment, I understand that the Registration Fee is NON-REFUNDABLE.  I also understand and agree that, as a condition of participation in the 2016 Alzheimer’s Family Support Walk, I will be required to sign this Indemnification and Waiver of Liability before participating in the event(s).  I certify that I have represented by my application for entry that my physical condition and training for this event is adequate to participate safely in this event and I acknowledge that I am familiar with the distances, rigors and risk of the event involved.  If I should suffer injury or illness, I authorize the official of the event to use their discretion to have me transported to a medical facility and I take full responsibility for this.  I hereby agree that in the event of cancellation due to storm, rain, winds, inclement weather or other ‘Act of God’ conditions, my registration will not be refunded.  In consideration of this entry, I intend to be legally bound, and do hereby for myself, heirs, executors and administrators, waive, release and discharge any and all claims against Alzheimer’s Family Organization, all Affiliates of The Villages, organizations sponsoring or conducting this event, or their volunteers, employees, representatives, or successors for any and all damages or injuries I may suffer.  I hereby grant permission for the use of my name and picture in any broadcast, brochure, or account of this event.  There will be NO SMOKING permitted on event premises.

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