|
------------------------------------------------------------------------------------------------
Bloomington's
Breast Cancer Awareness Walk
PLEASE BRING THIS COMPLETED FORM TO THE WALK
|
Please
Print:
Name:
_________________________________________________
Street
Address:___________________________________________
City:
________________________State:______ Zip:_____________
Email Address: ____________________(To
be used only for reminder for next year) |
 |
WAIVER:
In consideration of being permitted to
participate in the Breast Cancer Awareness Walk, I hereby for myself, my
heirs, and personal representatives assume any and all risks which might be
associated with the event. I further waive, release, discharge, and covenant
not to sue the sponsors, organizers, volunteers, the City of Bloomington and
their representatives, or successors and assigns, for any and all injuries
or damages of any kind whatsoever suffered as a result of taking part in the
Breast Cancer Awareness Walk and any related activities. I also agree to the
use of any photo, film or video tape of the event for any purpose.
Signature:
_____________________________________________ IU
Student? _______Yes
Parents signature for children under
18 years old: __________________________________________________
The
Walk is FREE, but donations are gladly accepted!
October 16,
2010 * City Hall * 8:30 a.m. Registration
------------------------------------------------------------------------------------------------
|
