#EndoRun Registration Form

#EndoRun

It is the first Endometriosis Walkathon movement in India to support, bring together endo warriors, their families, HCPs, researchers, and patient advocates calling for greater support and resources for the individuals and families affected by it.

Full Name

First NameLast Name

Age

Email

example@example.com

Phone Number

Area CodePhone Number

Emergency Contact Person (For EndoRun)

First NameLast Name

Emergency Person Phone Number

Area CodePhone Number

EndoRun in Delhi (12th March, Sunday)EndoRun in Mumbai (25th March, Saturday)EndoRun in Pune (26th March, Sunday)EndoRun in Hyderabad (28th March, Tuesday)EndoRun in Kolkata (3rd April, Monday)

Will you bring anyone with you? Please mention number of people.

E.g., 1, 2, 3.....

YesNo

Disclaimer statement

I affirm and state that I am physically fit and sufficiently able for participating in the designated event. I have been certified to be physically fit by a licensed medical practitioner and agree to indemnify the organizers, employees and associates, the organizing committee and any other person connected to the event against any losses, damages, costs, liabilities, claims, or proceedings arising out of any misstatement and or misrepresentation made herein.

Attention please!

It is important to note that weather conditions can have a significant impact on our health, however we will be taking necessary steps but we strongly advise our participants to stay informed about the changing weather conditions in their area and to take necessary steps to remain hydrated and protected during the event.

We would like to hear if you want to mention anything else.