This is only a preview. No submissions will be saved, nor will emails be sent.
Name
*
$
First Name
Last Name
$
One Time
Recurring
Address
*
$
Address Line 1
Address Line 2
City
State
Zip
$
One Time
Recurring
Email
*
$
$
One Time
Recurring
Phone
*
$
$
One Time
Recurring
Early Registration (On Or Before 3/31/23 Only!)
*
$
$
x $20.00
One Time
Recurring
Register On Or Before March 31st To Get $5 Off Registration!
Individual Walk Ticket
*
$
$
x $25.00
One Time
Recurring
VIP
*
$
$
x $350.00
One Time
Recurring
Registration Table Signage, Inclusion in Email Blast/Newsletter, Four (4) Complimentary T-Shirts & Walk Entries
Bronze
*
$
$
x $1,000.00
One Time
Recurring
Name/Logo on T-Shirts, Registration Table Signage, Social Media Posts & Inclusion in Email/Newsletter, Six (6) Complimentary T-Shirts & Walk Entries, Giveaway Opportunity
Silver
*
$
$
x $2,500.00
One Time
Recurring
Course Banners/Markers, Name/Logo on T-Shirts, Table Setup/Exhibit Space at Event, Social Media Posts & Inclusion in Email/Newsletter, Eight (8) Complimentary T-Shirts & Walk Entries, Giveaway Opportunity, Giveaway Opportunity, Verbal Recognition on Stage/Awards Presentation
Party
*
$
$
x $4,000.00
One Time
Recurring
Course Banners/Markers, Name/Logo on T-Shirts, Sponsor of After Party/Entertainment, Table Setup, Social Media Posts, Ten (10) Complimentary T-Shirts & Walk Entries, Giveaway Opportunity, Verbal Recognition on Stage/Awards Presentation
Gold
*
$
$
x $5,000.00
One Time
Recurring
Everything From Silver Plus: Signage @ Hydration Station, Four (4) Additional Complimentary T-Shirts & Walk Entries (For A Total of 12), Scholarship for One (1) Child To Attend Team Walker Academic Programs
Platinum
*
$
$
x $7,500.00
One Time
Recurring
Everything From Silver Plus: Start/Finish Banner, Six (6) Additional Complimentary T-Shirts & Walk Entries (For A Total Of 14), Scholarships for Three (3) Children To Attend Team Walker Academic Programs
T-Shirt Size
*
$
$
One Time
Recurring
Please List Your Preferred T-Shirt Size(s) And We Will Accommodate As Best As We Can!
Team/Group Name
*
$
$
One Time
Recurring
If You Are A Part Of A Team/Group Or Wish To Start One, Please Enter The Name Here! If Not, Leave Blank!
Donate to the Walk
*
$
$
One Time
Recurring
If You Cannot Make It But Still Wish To Support The Walk, Please Copy & Paste The Following Link Which Will Re-Route You https://www.eleoonline.net/Pages/WebForms/Mobile/ShowFormMobile.aspx?id=6c0690a2-4664-4e75-993e-5bf3911f8c26&linkto=634
Waiver of Release & Liability
*
$
1. In recognition of the risk of injury while participating in the Walk for Team Walker (the “Event”), and as consideration for the right to participate in the Event, I hereby for myself, my heirs, executors, administrators, assigns, or personal representatives knowingly and voluntarily enter into this waiver and release of liability (“Agreement”) and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Event, and do hereby release and forever discharge the Event and its affiliates, managers, members, agents, attorneys, employees, volunteers, heirs, representatives, predecessors, successors and assigns, ELEO and its affiliates, Braintree and its affiliates, managers, members, agents, attorneys, employees, volunteers, heirs, representatives, predecessors, successors and assigns, the event site and its agents, attorneys, employees, volunteers, heirs, representatives, predecessors, successors and assigns and all sponsors and/or beneficiaries of the Event (collectively “Hosts”) from any and all liability, claims, demands, damages, actions, or causes of action now existing or which hereinafter may arise as a result of my participation on the Event, whether any injury is caused by negligence of the Hosts, the negligence of myself or third parties, the conditions of the course or any other cause including illness from COVID-19.
2. I agree to indemnify and save harmless the Hosts against any and all claims suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorneys’ fees, if litigation arises on account of claims made by me or anyone on my behalf.
3. I recognize that photographs, video recordings, and promotional materials will be taken during the Event. I agree to grant the Hosts full permission to use any photographs and/or video recordings of the Event that contain my likeness for any purpose whatsoever.
4. I acknowledge that this Agreement is the entire agreement between the Hosts and me, and that this Agreement cannot be modified or changed in any way by representations or statements of the Host or by me.
5. I hereby declare that I have read and fully understand the terms and conditions of this Agreement and I consent to all of the terms and conditions as mentioned here.
$
One Time
Recurring
Gift Note
*
$
$
One Time
Recurring
I wish to pay the day of or mail a check
I agree to pay the 2.3% average credit card processing fee associated with my contribution