Membership ID*

District Number*

Post Number*

Name*

Date of Death*

Who Submitted the Change?

First Name*

Last Name*

Phone*

Email*

DOB*

Emergancy Contact Information

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First Name*

Last Name*

Phone*

PLEASE CHECK THE BOX TO AGREE: I am medically cleared for physical activities.

PLEASE CHECK THE BOX TO AGREE: In consideration of you accepting this entry, I, the participant, intending to be legally bound do hereby waive and forever release any and all rights and claims for damages or injuries that I may have against the Veterans of Foreign Wars (VFW), and all of their agents assisting with the event, sponsors and their representatives, volunteers and employees for any and all injuries to me or my personal property. This release includes all injuries and/or damages suffered by me before, during or after the event. I recognize, intend and understand that this release is binding on my heirs, executors, administrators, or assignees. As with any physical activity, I should not enter this run/walk unless I am medically able to do so and properly trained. I assume all risks associated with running/walking in this event including, but not limited to: falls, contact with other participants, the effects of weather and course conditions, and waive any and all claims which I might have based on any of those and other risks typically found in performing this type of physical activity. I acknowledge all such risks are known and understood by me. I agree to abide by all decisions of any event official relative to my ability to safely complete the event. I certify as a material condition to my being permitted to enter this event that I am physically fit and sufficiently trained for the completion of this event and that a licensed Medical Doctor has verified my physical condition. In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to the Event Director to secure from any accredited hospital, clinic and/ or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment and hospitalization. As it applies to my participation in this event, I agree to abide by the Center for Disease Control (CDC)'s recommendations for the prevention of the spread of COVID-19 and attest to having read the CDC's guidance at: https://www.cdc.gov. Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, video graphic or electronic recording of this event for legitimate purposes. This event follows the standard running/walking industry policy: All entry fees are non-refundable. We reserve the right to postpone or cancel the event due to circumstances beyond our control such as a natural disaster or emergency or as required to protect the safety of participants and staff. I understand that my entry fee is nonrefundable. By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above release and waiver, including the no refund policy.

Shirt Information

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Color/Size* White/Medium White/Large White/XL Pink/Small Pink/Medium Pink/Large