Register for 2018 Stead Tread Fun Run
Please fill out all required fields
**Patients at Lincoln Community Health Center run/walk for free, but should still register by completing this form and waiver. Contact us via our website (www.steadtread.org) for questions!**
Are you a patient at Lincoln Community Health Center?
Age on day of race
(In order to receive your Stead Tread 2018 T-shirt, you or a representative must pick it up on race day)
NOTE: Due to great demand, we have run out of some T-shirt sizes! If your size is not available, we will be offering discounted 'no T-shirt' registrations for $20 on the morning of the race (cash/check only).
Choose your size
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Emergency Contact Phone Number
Waiver of Liability: I intend to participate in the 2018 Stead Tread Run/Walk. I understand there may be certain dangers and exposure to physical injuries in pursuing this fund-raising effort, and I hereby voluntarily assume all risk to myself and my property arising from my participation in this event. I assume such risks regardless of their causes. In consideration of the Duke Internal Medicine Residency Program, Duke Department of Medicine, Duke School of Medicine, Duke University Medical Center, and Duke University permitting me to participate in this fund-raising effort, I will not hold the Sponsors and Contributors of this event, Duke Internal Medicine Residency Program, Duke Department of Medicine, Duke School of Medicine, Duke University Medical Center, and Duke University, their trustees, officers, agents or employees, in both individual and representative capacities, liable in damages for any injuries I might sustain while getting to, during, or while leaving this activity. I release, discharge and hold forever harmless the aforementioned parties from any and all liabilities, claims, damages, or losses stemming from injury to person or property that arises from, or in any way relates to my participation in this activity.
Permission for Photographs/Video Taping: I authorize Duke to permit its representatives and/or the news media to take photographs or video tape of me or my dependent. I understand that Duke retains no control of the use of any photograph or videotape that is released to or taken by the news media. Expiration date or an expiration event: 100 years from today's date.
Permission for Release of Information for Marketing/Advertising Purposes: I authorize Duke to take photographs of me or my dependent while I (he/she) am (is) a patient for use in marketing or advertising its services. I understand that the photographs, video tape or audio tape will be used primarily for marketing or advertising purposes, such as brochures, newsletter, Duke Web site and advertising. Expiration date or an expiration event: 100 years from today's date. I understand that: If the materials are copyrighted by Duke, the material will be under the control of Duke. I understand, however, that once information and/or materials are released to the public information media including but not limited to television, newspaper, magazine, radio, and the internet Duke no longer has control over their use. I hereby release and discharge Duke as well as their assigns and/or representatives from any and all claims and demands arising out of or in connection with the use of the photographs, video tape, and audio tape. I will receive no compensation for consent for the release of this material. I have the right not to be photographed, videotaped or audio taped or have information concerning me or my dependent released to the media. This authorization may be revoked at any time. Revocation must be made in writing and sent to the appropriate news office (see contact information below). Such revocation shall not affect disclosures prior to revocation. I understand that Duke retains no control over the use of this information once it is released to the media.
I have carefully read this Release and Assumption of Risk and fully understand its contents. I voluntarily sign this agreement and realize that this will bind me, my heirs, and my personal representative. Parent or guardian must sign if participant is less than 18 years of age.
Check if you have read and agree to abide by the waiver above.
Confirm your agreement to abide by this waiver here by typing your first and last name. Contact us via our website (www.steadtread.org) for questions.
NOTE: The 'Submit' button below will direct you to PayPal.com, where you can securely pay for your race registration using a credit card or PayPal account. If you DO NOT have a PayPal account, you may securely pay for your registration as a guest on PayPal using a credit card! Please contact us via our website or at steadtread5K@gmail.com for any questions regarding payment for Stead Tread 2018.
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