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GLUTEN INTOLERANCE GROUP

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Registration Form
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Please complete registration form(s) and mail with payment to:
WV GIG
Karen Daniel
340 Green Acres Dr
Hurricane, WV 25526

Fees:
Before Aug. 5th..................After Aug. 5th
$15 per person.....................$20 per person
$40 per family......................$50 per family

*T-shirts will be reserved and given to the first 100 who register.

GIG is a 501c3 non-profit organization. All donations are tax deductible. Canceled checks below $250 qualify as a receipt.

Registration Form

Walker’s name _____________________

Address____________________________

___________________________________

Phone #____________________________

Does anyone in your family have celiac? yes______no______

*T-shirt size Adult L___ Adult XL_____

Child L_____ Adult XXL_____

Total entry fees ______________
Liability Waiver: I know that walking or running for fun is a potentially hazardous activity. I should not enter and walk unless I am medically able. I agree to abide by any decision of an event official relative to my ability to participate. I assume all risks associated with this event including, but not limited to, the effects of weather, traffic, conditions of the path, all such risks being known and appreciated by me. Having read this waiver I, for myself and anyone entitled to act on my behalf, waive and release GIG, all sponsors, their representatives and successors, and all volunteers from all claims of liabilities of any kind. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of the event for a legitimate purpose.

X_____________________________________
Authorized signature (must sign to participate)


 
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