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Erase Poverty 2014 Walk-A-Thon_ Enrolment Form by hedongchenchen

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									                       Erase Poverty 2014 Walk-A-Thon!
            Sunday March 23, 2014 Time: 10:00 am – 12:00 (noon)

   Location: Garden at Bowen Road and Bowen Drive (1 Km stone mark from Magazine Gap
                                         Road)

   A generous donor has committed to donate HK$250 to Erase Poverty for each person that
                enrolls in the Walk-athon and walks a minimum of 1Kilometre.

                                Registration deadline March 14th, 2014

                                       Enrolment Form
  Name in English: __________________ (Surname) ______________________(First)

  Date of Birth: ____________________ Male / Female _____________________

  Tel No: ________________________ Mobile No: _____________________________

  Email Address: _____________________________

                   “√ ”
                   where
                   applicable

      Individual   o
        Family     o                       Name                 Relationship      Gender   Age




        Team       o
                                       Team Name:_______________________

                                       Team Leader and Mobile #:_______________

                                       Number of Team Members: ___________________




Email: contact@erasepoverty.hk            Fax: 3747-9873                Web: www.erasepoverty.hk
                                 WAIVER OF LIABILITY AND DECLARATION

  As a condition of my participating in the 2014 Erase Poverty Walkathon (the Event), I
  confirm to

  Erase Poverty, Event sponsors, their partners and related companies, (collectively
  “Organizers”) as follows:

    I assume full responsibility for myself and my family, and release, and hold harmless
  the Organizers from and against any and all rights and claims for damages and causes
  of suit or action with respect to my participation in the Event.

    I understand that by participating in the Event there may be risks of injury and or
  loss,and I an entering the Event of my own free will.

    I consent to the use by the Organizers of my photos, videos, name and comments in

  connection with the operation and promotion of the Event.


 Applicant’s Signature: _________________________ Date: ______________________________________


 Parent/Guardian’s Agreement Applicants aged below 18 must complete this part

 Parent / Guardian Signature: _____________________ Date: __________________________________

 Name of Parent / Guardian: ____________________________________




Email: contact@erasepoverty.hk           Fax: 3747-9873                Web: www.erasepoverty.hk

								
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