Online Registration – The Arc Los Angeles & Orange Counties

WALKER REGISTRATION FEE:
Before Feb. 28th – Early Bird Price: $25
March 1st – 29th: $30
DAY OF EVENT $35
UNDER 10 FREE
On-site Registration opens at 7am
Non-Refundable
RAIN OR SHINE EVENT

ASSEMBLE YOUR COMPANY OR FAMILY TEAM (4 OR MORE MAKE A TEAM)
• Anyone can form a team. We invite companies, organizations and clubs to gather their family and friends. There is not limit to team size.
• Wear your family or company T-Shirt. Include all adults, youth, and children

The Arc's WALK FOR INDEPENDENCE Online Registration Form

WALKER REGISTRATION FEE
Price: $25.00 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
TOTAL
$0.00

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The Arc's WALK FOR INDEPENDENCE Online Registration Form

CHILD WALKER - 10 AND UNDER ARE FREE

ADDITIONAL DONATION (not walker registration fee)

GROUPS OF 4 OR MORE

SPIRIT WALKER

PERSONAL INFORMATION

WAIVER

WALKER INFORMATION

YOUR REGISTRATION IS ALMOST COMPLETE

CREDIT CARD INFORMATION

TOTAL

To see The Arc Walk updates on Facebook, CLICK HERE