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Buddy Walk

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Registration / Donation Form

Thank you for your interest in the Central Iowa Buddy Walk!

Online registration for the 2010 Buddy Walk to be held August 28 is now open!

You can register your team, get a team page, upload a photo (if you want) and email your friends and family! Go to www.events.org/GIGI01/cpage.aspx You will be directed away from this website.

If you are unable to attend the Buddy Walk, but would like to make a tax-deductible donation, you can do that too!

Click Here To Download Buddy Walk Brochure

Contact Information

First Name:

Last Name:

Name of person you are participating for/sponsoring or your team name:

Address:

City:

State:

Zip:

Phone:

E-mail Address:

How did you hear about the Buddy Walk?
Family / Friend
Up with Down Newsletter
Registration Mailing
Up with Down Web Site
Newspaper Article
Poster / Brochure
Employer's Volunteer Web Site
Other

Registration - Names of all participants

First & Last Name	Age	T-Shirts
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Donations

Additional Donation: $

I am unable to participate in Buddy Walk, but I would like to make a donation of $

Waiver & Release of Liability

Waiver: In consideration of me and/or my minor child(ren) being permitted to participate in the 2009 Buddy 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 Up With Down Family Support Group, its officers, sponsors, organizers, volunteers or other representatives or their successors and assigns, for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child(ren) as a result of taking part in the events and any related activities. I also authorize the use by the Up With Down Family Support Group of any photo, film or videotape taken of me or my minor child(ren).

I understand and accept the waiver & release of liability agreement.

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