The Arc Walk: Registration Form – The Arc Los Angeles & Orange Counties

WALKER REGISTRATION FEE

Price: $30.00 Quantity:

CHILD WALKER - 10 AND UNDER ARE FREE

CHILD WALKER 10 AND UNDER: FREE, BUT MUST BE REGISTERED DURING CHECKOUT

CHILD WALKER REGISTRATION

Price: $0.00 Quantity:

ADDITIONAL DONATION (not walker registration fee)

Support individuals with intellectual and developmental disabilities. All additional donations are used to support The Arc Walk for Independence, but are not walker registration fees. The Arc Los Angeles & Orange Counties is a tax-exempt organization, under Section 501(c)(3) of the Internal Revenue Code; therefore, your donation is deductible to the full extent allowed by law.

ADDITIONAL DONATION AMOUNT (not walker registration fee)

In addition to the Walker Registration Fee, I would like to make a tax-deductible donation of:

GROUPS OF 4 OR MORE

GROUPS OF 4 OR MORE MAKES A TEAM

If you have a team of 4 or more, please enter your team name here. If you would like a team sign, please contact our office at (562) 803-4606 x221. Sign deadline is March 24th.

SPIRIT WALKER

Spirit Walkers- My spirit is willing, but my feet are not. Please include me among the “Spirit Walkers”.

SPIRIT WALKER DONATION AMOUNT

Total

$0.00

PERSONAL INFORMATION

Name of person filling out this form

Name*

Prefix First Middle Last

Street Address Street Name City State ZIP / Postal Code Country

Phone*

Please enter your phone number where we can reach you if we have any question about your registration

Email*

WAIVER

Please read

CHECK BOTH BOXES BELOW IF YOU AGREE TO THE TERMS*

All listed Walkers hereby waive all claims against The Arc Los Angeles & Orange Counties, sponsors or any personnel for injury I might suffer in this event. I attest that I am physically fit and prepared for this event. I grant full permission for organizers to use photographs of me and quotations from me in legitimate accounts and promotions of this event.

I HAVE READ AND UNDERSTAND THE TERMS OF THIS WAIVER
CHECKING THIS BOX SERVES AS MY DIGITAL SIGNATURE

WALKER INFORMATION

All Walkers must be listed regardless of age.

FILL OUT THE FORM BELOW FOR EACH WALKER*

FIRST NAME	LAST NAME	STREET ADDRESS	STREET NAME	CITY	STATE	ZIP CODE	AGE

YOUR REGISTRATION IS ALMOST COMPLETE

Thank you for your registration to The Arc's 22nd Walk for Independence! We are excited to have you join us as we walk for hope and Walk The Walk. We will mail your wristband, which must be worn for entrance into the event, as well as picking up your complimentary breakfast burrito, courtesy of Acapulco Restaurant.

CREDIT CARD INFORMATION

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

BILLING INFORMATION*

Same as previous

Street Address Street Name City State ZIP / Postal Code Country

BILLING ADDRESS

COMMENTS

If you have any comments regarding registration, please use the box below.

TOTAL

$0.00

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