Questions? Please call (608) 873-2334 Community Walk Commitment Form Register HereI wish to register as:* Walker Sponsor Both a Walker and Sponsor Walker Sign UpContact Name* First Last Contact Email* Contact Phone*Contact Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many Participants are you registering?*The cost is $15 for each Participant.SELECT123456Only for Participants Registered by 5/31/22 select T-Shirt size(s).T-Shirt Size for Participant 1SELECT SIZEYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult 2XLargeAdult 3XLargeAdult 4XLargeT-Shirt Size for Participant 2SELECT SIZEYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult 2XLargeAdult 3XLargeAdult 4XLargeT-Shirt Size for Participant 3SELECT SIZEYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult 2XLargeAdult 3XLargeAdult 4XLargeT-Shirt Size for Participant 4SELECT SIZEYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult 2XLargeAdult 3XLargeAdult 4XLargeT-Shirt Size for Participant 5SELECT SIZEYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult 2XLargeAdult 3XLargeAdult 4XLargeT-Shirt Size for Participant 6SELECT SIZEYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLargeAdult 2XLargeAdult 3XLargeAdult 4XLargeCost for Participants Price: $0.00 Release of Claims: RELEASE OF ALL CLAIMS FOR PERSONAL INJURY AS A PARTICIPANT IN THE COMMUNITY RECOGNITION WALK. In consideration for my rights to participate in this race event, I hereby release the Stoughton Hospital Foundation, Stoughton Health, all sponsors, and all walkofficials from any liability of personal injury incurred by me in participating in this race. I further certify that I am in proper condition to participate in this walk, and am aware of all inherent risks of said participation.Release Signature* Reset signature Signature locked. Reset to sign again Today's Date* MM slash DD slash YYYY Sponsorship AgreementContact Name* First Last Title* Organization / Company Name* Website Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Sponsorship Type* Event Co-Sponsor with Foundation ($1,000) includes large logo, marquee displays, logo on flyers and website registration form Large T-Shirt Logo ($500) Medium T-Shirt Logo ($250) Small T-Shirt Logo ($100) Please email your logo to foundation@stoughtonhealth.com.Total Payment $0.00 Please Note: You do not need to have a PayPal account to register. PayPal allows you to pay as a guest.Billing Name* First Last Billing Email* CommentsThis field is for validation purposes and should be left unchanged.
