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Stories Therapeutic Massage

STEP 1:

Please use the form at right to register for any upcoming event.

STEP 2:

After you submit the form at the right you'll be taken to a purchase path to choose the event you are registering for and input your payment.

Registration

Registration for any event is a 2-part process. 

  1. First, complete the registration form below completely

  2. Second, you'll be taken to our purchase page to select the event and options you have indicated below.  Please be sure your form below and your selections in step 2 match. 

If you have any questions please contact us.

Last Name *
First Name *
Address *
City *
State *
ZIP *
Day Phone *
Night Phone *
E-mail Address: *
Date of Birth *
Gender *Male
Female
Emergency Contact Name *
Emergency Contact Phone *
Medical Conditions
Medical Prescriptions
Medical Allergies
Cancer Survivor?
Date of Diagnosis
I initial that I agree to the required fundraising minimums *
I (We) am/are registering as a team member. Team Name
Other Family Members' Names and Ages, if registering for Family Option
I have a spouse/partner with cancer
I have a parent with cancer
I have a sibling wiht cancer
I have a child with cancer
I have a friend with cancer
I have a relative with cancer
I know someone who has died from cancer
I know someone who has cancer
I work with cancer survivors
I want to make a community for people with cancer
ELECTRONIC SIGNATURE - Please input your full, complete legal name (no initials). This will signify your full agreement to the below contract of responsibility and waiver and confirms that all information is complete and accurate to the best of your knowledge. *
* Required

Contract of responsibility and waiver.

I understand that participating in the We Will Because We Can TM Bike Ride and the celebration events are potentially hazardous activities. I will not participate in the We Will Because We Can TM Bike Ride unless I am medically able to do so and am properly trained. I shall voluntarily examine all risks associated with participating in these events, including without limitation, falls, contact with other participants and volunteers, the effects of weather, including extreme temperatures or conditions of the road, participating in events along the route and after, all such risks being known and appreciated by me. I assume the risk of all conditions during the We Will Because We Can TM Bike Ride and celebration events and waive all specific notice of the existence of such conditions, and I will assume and pay my own medical and emergency expenses in the event of an accident, illness, or other incapacity regardless of whether I have authorized such expense.

Having read this waiver and knowing these facts and in consideration of my registration acceptance, I, for myself and anyone acting on my behalf, waive and release the We Will Because We Can TM Bike Ride, the Cancer Community Renewal Project, all sponsors, contracted facilities, officials, employees and agents from all claims of liabilities of any kind arising out of my participation in this event, including damage or loss to my person and property which may be caused by any act, or failure to act, by the above persons and entities. I also understand and agree that any sponsor, and The Cancer Community Renewal Project, may subsequently use, for publicity or promotional purpose, my name or pictures of me participating in this event without liability or obligation to me. I will wear a helmet approved by ANSI or Snell and will obey the rules of the road.

 

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