Helping Employees Achieve Lifetime Total Health (HEALTH)

Name (First & Last):

Address:

City, State, Zip:

Phone Number:

Email Address:

Which Course will you be taking?

Team Name (Leave blank if registering as an individual):

Everyone on the team must register separately.

Entry Release: In consideration of acceptance of this registration, I waive any and all claims for myself and my heirs against UNCP, HEALTH Committee members, volunteers or other persons including sponsors, for any illness or injury which may directly result from my participation in this event. I further state that I am in proper physical condition to participate in this event and agree that none of the above parties are under obligation to provide a physical examination or other evidence of my fitness to participate in any event, with this being my sole responsibility. I also give permission for the free use of my name and photo in any news coverage
or publicity of subsequent events.

Submission of this form signifies agreement with the Entry Release.