Last Name
Tele:
First Name
Street
Zip
State
City
Family walker
Individual walker
Team Captain
No Team Affilation
Team walker
Team or Captain Name
Cannot walk but would like to make a Donation
Volunteer
T Shirt Size (Unisex)
Email Address
Small
Medium
By submitting this form, I hereby waive all claims
against NAMI National, NAMI Mobile, U
SA
,
or any
s
ponsor, or any personnel for any injury that I might
suffer in this event. I attest that I am physically fit
and prepared for this event. I grant full permission
for organizers to use photographs of me
quotations from me in legitimate accounts and
promotions of this event.
Large
X Large
2X Large
Yes, I have read and agreed
