Registration Information Name______________________________________________________________________ Address_______________________________City__________________State____Zip Code__________ Email address:________________________________Telephone#_________________________ T-Shirt Size: S__ M__ L__ XL__ Other_______________________ Emergency Contact_____________________________________Telephone#_______________________ Group Name: (Complete separate form for each participant) _________________________________________________________ Number in Group ______________Amount Paid ___________________ Make Checks Payable to: Lupus Foundation of America, Memphis
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Waiver Please read and sign below: I, the undersigned, agree to hold harmless Neshoba Community Resource Center, New Sardis Baptist Church, City of Memphis, Overton Park, Lupus Foundation of America and all sponsors or organizations associated with this walk from all costs, expenses and liability arising out of my participation in this event. I waive all claims for damage or loss to me or my property by participating in this event, and thereby assume liability for any loss, damage or expenses from such event. I attest and verify that I am physically fit for this walk. I grant full permission for organizations to use photos, videos or any record of this event, in which I may appear, for any legitimate purpose.
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