Contact us for more information about our Prostate On-site Screen program (480) 964-3013

pop@prostatecheckup.com

Walk For POP Registration

Walk-For-POP-Logo

Please fill out the form below to register for the Tim Barber Walk for POP event. If you are registering a group of people as a team, you will need to provide names and t-shirt sizes for each team member. If you have any questions about signing up please call our offices at 480-964-3013.

ssl-0-lockPayments are made securely via Paypal


Registration for adults is $
 
and children under 12 is $15

Your Info

If you will not be attending the event we will mail your shirt to you.

Payment Information

Total Participants:
 
Registration Fee: $
 
Shipping Cost: $
 
Total: $
 
Once you have submitted this form you will be taken to Paypal to complete your payment.

Event Waiver

PHOTOGRAPHIC RELEASE: I give my full consent and permission to Prostate On-Site Project, its local affiliates and races (as defined below), their sponsors and corporate sponsors, their successors, licensees, and assigns the irrevocable right to use, for any purpose whatsoever and without compensation, any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of this event (the "Event"). WAIVER AND RELEASE OF CLAIMS: I understand that my consent to these provisions is given in consideration for being permitted to participate in this Event. I further understand that I may be removed from this Event if I do not follow all the rules of this Event. I am a voluntary participant in this Event, and in good physical condition. I KNOW THAT THIS EVENT IS A POTENTIALLY HAZARDOUS ACTIVITY AND I HEREBY VOLUNTARILY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR, AND THE RISK OF, ANY INJURY OR ACCIDENT THAT MAY OCCUR DURING MY PARTICIPATION IN THIS EVENT OR WHILE ON THE PREMISES OF THIS EVENT. I, FOR MYSELF, MY NEXT OF KIN, MY MINOR CHILDREN THAT ATTEND THE EVENT, MY HEIRS, ADMINISTRATORS, AND EXECUTORS, HEREBY RELEASE AND HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST PROSTATE ON-SITE PROJECT, AND ALL OTHER PERSONS OR ENTITIES ASSOCIATED WITH THIS EVENT (COLLECTIVELY, THE "RELEASES") FOR ANY INJURY OR DAMAGES I MIGHT SUFFER IN CONNECTION WITH MY PARTICIPATION IN THIS EVENT OR WHILE ON THE PREMISES OF THIS EVENT. THIS RELEASE APPLIES TO ANY AND ALL LOSS, LIABILITY, OR CLAIMS I MAY HAVE ARISING OUT OF MY PARTICIPATION IN THIS EVENT, INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY OR DAMAGE SUFFERED BY ME OR OTHERS, WHETHER SUCH LOSSES, LIABILITIES, OR CLAIMS BE CAUSED BY FALLS, CONTACT WITH AND/OR THE ACTIONS OF OTHER PARTICIPANTS, CONTACT WITH FIXED OR NON-FIXED OBJECTS, CONTACT WITH ANIMALS, CONDITIONS OF THE PREMISES OF THE EVENT, NEGLIGENCE OF THE RELEASEES, RISKS NOT KNOWN TO ME OR NOT REASONABLY FORSEEABLE AT THIS TIME, OR OTHERWISE. This Photographic Release and Waiver and Release of Claims (collectively, the "Release") shall be construed under the laws of the state in which the Event is held. I understand that I have given up substantial rights be signing this Release, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.
 
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