Hope Hike: The Lisette C. Johnson Memorial Hike

Hope Hike 2011 Registration Form

Name First Name: Last Name:
Address

Street Address:

City: State:

Phone

Home Phone:

Cell Phone:

Email
Gender

Male Female

Are you an ovarian cancer survivor?

Yes No

Are you hiking in honor of or in memory of someone?

Yes No

If yes, who?:

You plan to hike?

West Summit Trail (1.5 miles, yellow blazes mark trail)

Base Trail (3.5 miles, light green blazes)

Kingfisher Trail (0.5 miles, paved)

Virtual Hiker (I won't be able to hike but will be at Pinnacle Mountain to show my support)

Are you on a team?

Yes No

If yes, what is the team name?:

Are you the team captain?

Yes No

If no, who is your team captain?:

Age on race day
Guardian, if under 18 First Name: Last Name:
Liability Waiver

I know that hiking is a potentially dangerous activity. I should not participate unless I am medically able and properly trained. I agree to abide by any decision of an event official relative to my ability to safely complete the hike. In consideration of the event officials' acceptance of this entry, all participants, intending to be legally bound hereby, for myself, my heirs, executors, administrators, and assigns waive and release Hope Hike Organizers and Volunteers and any and all sponsors and representatives, successors and assigns from any and all rights and claims for damages I may have arising out of any injuries and/or illnesses suffered by me or as a result of this event, including those which may be attributed to weather conditions. I attest and verify that I will participate in this event as a hiker entrant, that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use my name and any photographs, videotapes, motion pictures, recordings or any other record of me participating in this event for any purposes without obligation, compensation or liability to me. I have read the entry information provided and certify my compliance by my signature on this registration form. I agree that checking the box below and submitting this form will constitute an electronic signature that is legally binding as if it were a physical signature.

By checking this box and submitting this Registration Form, I agreed to the above event disclaimer or am the parent/legal guardian of the previously named minor under 18 years of age or legal guardian of previously named incapacitated and/or mentally challenged person and agreed to the above event disclaimer on their behalf.