Walk 'n Roll for ALS: 2021

Registering as an Independent (not part of a team)
Please fill out the following. (An * indicates a required field.)

Name on Your Web Page*

Your own web address will be
https://ssl.charityweb.net/alsofmichigan/walknroll/ENTERED_TEXT.htm

Fund Raising Goal*

Your Name and Contact Info:

You will be able to log in to personalize your own web page and view donations.

Title

First Name*

Last Name*

Address*

Address, line 2

City*

State/Province*

Zip/Postal Code*

Country*

Preferred Phone*

E-mail Address (and username)*

Confirm E-mail Address

Password*

Confirm Password*

Age (for runners only)

Gender (for runners only)

Male Female

Waiver**

I hereby waive all claims against ALS of Michigan, sponsors or personnel for any injury that I may suffer from my participation in this event. I grant full permission for organizers to use photographs, videotapes, motion pictures, recordings or any other record of this event in which I may appear for any legitimate reason. Having read this waiver and knowing these facts, and in consideration of this acceptance of my entry, I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, covenant not to sue, and waiver, release and discharge ALS of Michigan, event officials, volunteers, and any other sponsors, suppliers, agents, independent contractors, employees and other personnel in any way assisting or connected with this event.

The power of teamwork!

Your Name and Contact Info: