Moc Walk 2015 Registration

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Registration form for walkers of Moc Walk 2015

Full Name *

E-mail: *

Please enter a valid e-mail to receive your sponsorship form and for event updates.

Address: *

Phone number: *

(Home, Cell, or Work)

Age: *

In case of emergency, please contact: *

Please include name, relationship to you, and contact number(s).

Declaration of amateur status

I certify that I am entering the "Moc Walk" 2015 at my own risk and shall not hold the Organizers responsible for any injuries, accidents or death, however caused before, during or after the walk. The information I have provided in this registration form is true and up to date.

Initial *

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