REGISTRATION

Embrace Your Voice Sexual Assault Awareness Walk

Saturday, April 27th 2019

Detert Park, Jackson

Registration/Liability Waiver

Embrace Your Voice 2019-Registration

Name *

First

Last *

Last

Email *

Phone

Additional family members attending (and ages)

Please list any additional family members attending the walk here. Please include ages.

Emergency Contact Name *

Emergency Contact Relationship

Emergency Contact phone *

DONATION

The walk is free, but donations in any amount are greatly appreciated. Proceeds benefit Operation Care and A Voice for the Innocent.

SIGNATURE *

BY TYPING YOUR NAME IN THE SIGNATURE BOX, YOU ARE CERTIFYING THE INFORMATION ABOVE IS TRUE AND CORRECT, AND YOU AGREE TO THE TERMS OF THIS REGISTRATION AND THE LIABILITY WAIVER BELOW.

DATE *

Message

Any additional information you want us to know.

Captcha

Liability Waiver

I, the undersigned, understand that there are risks inherent in any physical activity, and I accept full responsibility for my own health and safety during my participation in the Sexual Assault Awareness Walk. I agree that my participation is fully voluntary and that I will not hold any of the organizers involved responsible for any harm that may result from my participation in this event.