Southern New Mexico Down Syndrome Families
BUDDY WALK REGISTRATION FORM
Please complete this card and mail, with a check payable to
Southern New Mexico Down Syndrome Families, to 1322 Nightshade Ct. Las Cruces, NM 88007– before October 24, 2009. Registrations
will also be accepted on the day of the event.
PLEASE PHOTOCOPY THIS FORM AS NEEDED
Walker’s Name _______________________________________________________
Company/Team
Name __________________________________________________
Street Address ________________________________________________________
City
_____________________________ State _________ Zip _____________
Phone ________________________
E-Mail ______________________________
Total # of Walkers ____________________
YES! I want to walk to promote acceptance
and inclusion of all people with Down Syndrome.
Individual
$10.00
Family Registration (Up to 2 adults & 2 children) - $30.00
Additional Children 13 and Under - $5.00
All registration fees include a Buddy Walk T-Shirt: YS YM YL
M L XL
I cannot participate in the walk, but please accept my donation to support inclusion and acceptance of people
with Down syndrome:
$10
$20 $50
Other _______
- I have enclosed a check for my registration fee.
Payment method: Cash _____________
Check______________
Waiver: In consideration
of me and/or my minor child being permitted to participate in the Buddy Walk, I hereby–for myself, my heirs and personal representatives–assume
any and all risks which might be associated with the event. I further waive, release, discharge and covenant not to sue Southern New
Mexico Down Syndrome Families], its officers, employees, sponsors, organizers, volunteers or other representatives or their successors
and assigns, for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child as a result of taking
part in the events and any related activities. I also authorize the use by Southern New Mexico Down Syndrome Families of any photo,
film or videotape taken of me or my minor child at the event for any purpose.
Signature _____________________________________________
Date ____________
THIS REGISTRATION IS NOT VALID UNLESS SIGNED.
