Umstead Coalition - Walk/Run/Bike Pledge Form

If your browser doesn't support forms please print this page, fill it out, and mail it to: The Umstead Coalition; P.O. Box 10654; Raleigh, NC 27605-0654

2008 Walk/Run/Bike for Umstead

Saturday April 19

Pledge Form

First Name: Last Name

Walk Run Bike

Email address: (e.g.: you@aol.com)

Home phone (with area code): Work phone (with area code):

Address:
City/Town:	State/Prov.: Post./Zip Code:


	Supporter's Name	Supporter's Address	Amount Collected
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	TOTAL COLLECTED

(For more pledges please print additional pages)

WAIVER: I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I know that this event is a potentially hazardous activity and I hereby assume full and complete responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event. The undersigned hereby knowingly and willingly releases, remises, and forever discharges, and agrees to indemnify, defend, and hold harmless and covenant not to file suit against The Umstead Coalition, its employees, members, officers, directors, coordinators, volunteers, agents, sponsors, local affiliates, affiliated individuals and organizations, and permitted assigns (known collectively, the "Releasees"), for all losses, liabilities (including liability for attorney's fees), claims, damages, and costs (known collectively, "Losses") that may now exist or may hereafter arise in connection with or as a result of my own or my child's participation in the Walk/Run for Umstead and associated activities, including personal injury or damage suffered by me or others, whether same be caused by falls, contact with participants, conditions of the course, negligence of the Releasees or otherwise. If I do not follow all the rules of this event, I understand that I may be removed from the event. I give my full permission to The Umstead Coalition and its local affiliates and their sponsors and corporate sponsors to use any photographs, videotapes, or other recordings of me that are made during the course of this event.

IMPORTANT: PARTICPANTS UNDER AGE 18 MUST ALSO HAVE THIS FORM SIGNED BY A PARENT OR GUARDIAN.

Parent or Guardian sign: _____________________________________ Date: ________________

I want more information on Umstead Coalition Activities
I want to join the Umstead Coalition email list

Team Registration (if applicable)

Team Name

Team Captain

** Suggested minimum pledges: Adults, $25; Children (12 and under) $15.

Why do you like most about Umstead State Park? (OPTIONAL)

By clicking the send button you agree to accept all the conditions of the liability waiver.

rev. 4/13/08