Team VDF Registration Form

Fields marked (*) are required

First Name:*

Last Name:*

Street Address / Apt. Number:*

City:*

State / Province:*

Postal Code:*

Marathon Confirmation Code:*

(Please note, you must already be registered for the marathon prior to becoming a member of Team VDF)

Sex:
Male Female

Age:*
By checking this box, I agree that I am 16 or older:*

Daytime Phone:*

Nightime Phone:*

E-mail Address:*

Confirm E-mail Address:*

Note: Your E-Mail Address will only be used for correspondence relating to this event.

T Shirt Size:*
S M L XL

Is this your first marathon?:*
Yes No

Registration Fee is $35 (tax deductible).
Please visit the Team VDF Team site to pay your registration fee and create your own personal fundraising page.

As a member of Team VDF, you are agreeing to fundraise a minimum of $150 in addition your $35 registration fee.VDF will provide fundraising support and tips to help you meet your goal!

Enter the Amount you wish to pledge here:*

I am running in honor of:

Relationship to honoree:

Please add the following names to the Tribute Garden:

If you would like to share your story and reason for being a member of Team VDF, please do so below:

Waiver Release:*
Waiver Release: I hereby certify the following: (1) I represent and warrant that I have been advised to consult my doctor about whether I can safely participate in this program and whether there are precautions or limitations to my participation. (2) I understand and agree that there are inherent risks, both foreseeable and unpredictable, associated with any exercise program. I agree to assume and accept full responsibility in spite of and with full knowledge of these risks. My participation in this program is purely voluntary. I hereby fully agree and hold harmless the Vascular Disease Foundation, any sponsoring organizations, the Foundation's respective officers, directors, employees, agents, members, or volunteers, together with their insurers, of and from any and all liability, claims, damages or causes of action for any reason, including, without limiting the generality of the following, death, bodily injury, property damage or any other loss or inconvenience whatsoever, suffered by me at any time hereafter occurring as a result of my voluntary participation in Team VDF. I do hereby, for myself, my heirs, executors and administrators, fully waive, release and forever discharge any and all rights and claims for damages that I may have or that may hereafter accrue to me arising out of or in any way connected with my participation in this or any future programs. (3) I hereby consent that all interview, press interview, photographs, films, television and radio for the purpose of public and private release, showing or reproduction for public relations, marketing, education, or training may be used by the Vascular Disease Foundation without further consideration from me. I also understand that all donations to the Vascular Disease Foundation are non-refundable, non-transferable.

I have read and agree to the waiver above.*