I want to register as a Team Captain and form a Team

I want to register as a walker with a Team

I am registering as an individual walker (leave above fields blank)

Registration Fees:
$20 Individual Pre-registered
$40 Family Pre-registered

After March 21, 2012, Registration Fees are:
$25 Individual Day-of Registration
$50 Family Day-of Registration

If paying by credit card, please fill out the following:

In consideration of me and/or my minor child being permitted to participate in the Buddy Walk/Century Ride, 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 the DSOSN, 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 grant full permission for the event organizers to use any photo, film or videotape taken of me or my minor child and/or quotations of me or my minor child in legitimate accounts and promotions of this event.