Registration Form
Please complete the registration details, review the liability release statement, and submit any required signatures and payment.
I, understand that I (or my child) have voluntarily agreed to participate in a Society of Martha Washington activity entitled “Pink Walk” at Texas A & M International University. I further understand that I (or my child) will participate in physical activities during “Pink Walk.” Further, I understand that the Society of Martha Washington is the sponsor of Pink Walk. I agree to release the Society of Martha Washington, its members, officers and directors from any and all liability with reference to my (or my child’s participation) in “Pink Walk.” Also, by signing this form, I release the Society of Martha Washington from any liability and agree to indemnify it and hold harmless its officers, directors and members for any personal injuries, loss, or damage to property. By signing this, a Release from Liability Form, I understand that I have given up my future legal rights and take full responsibility of any personal injury, death, damage to person, or personal property damage associated with Pink Walk.
Liability Acknowledgment
*
Registrant Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Street
*
City
*
State / Zip
*
Participation Details
Participation Options
*
I am walking for a team
I will be volunteering (please contact me)
My monetary contribution is purely a donation
I am a breast cancer patient and/or survivor
Team Selection
*
Please Select
Martha & George
Ana Victoria Muller/Michael Barron
Vivian Covarrubias/Rodrigo Gonzalez
Sofia Gonzalez/Patricio Gonzalez
Camila Marroquin/William Edward Puig
Victoria Alejandra Landis/Arie Druker
Yvette Garcia-Bazan/Juan Carlos Salinas-Vidaurri
Miranda Ortega/Carlos Martinez
Dalia Cristian Trevino/Samuel Holloway
Andrea Daneli Rodriguez/Caleb Palomo
Team Minnie
TAMIU Dusty Health Heroes
Age Confirmation
*
I'm over 18
I'm not over 18
Participant’s Name
*
First Name
Last Name
Minor's Name
First Name
Last Name
Parent/Guardian Printed Name
T-Shirt and Attendance
T-Shirt Registration
Small (S)
Medium (M)
Large (L)
Extra Large (XL)
Extra Extra Large (XXL)
Register Attend
*
prev
next
( X )
Attendance
Event registration fee
Free
$
Free
Credit Card
Consent, Signature, and Date
Participant’s Signature
*
Parent/Guardian Signature
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: