Walk For Acupuncture Awareness 2019

1Independent
2Fee and Credit Card
3Review
4Receipt

Registering as an Independent (not part of a team)

Name on Your Web Page*

Your own web address will be
https://ssl.charityweb.net/ncsaam/2019walk/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.

First Name*

Last Name*

Address*

Address, line 2

City*

State/Province*

Zip/Postal Code*

Country*

Preferred Phone

E-mail Address (and username)*

Please add me to your e-mail distribution list.

Password*

Confirm Password*

Walk location*

*By clicking this box I acknowledge that I have read and understand the Waiver for this event.

I acknowledge that my participation in the NCSAAM Walk for Awareness involves a risk of injury, including bodily injury, and assume the risk for same. On my own behalf and on behalf of my heirs and legal representatives and to the fullest extent permitted by law, I hereby release and discharge the NCSAAM with any aspect of the walk. I acknowledge that my participation in the NCSAAM Walk is completely voluntary.

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