NAMI WALKATHON Registration

Mental Illness Awareness Walk Registration Form

Note that each member of a team must individually complete a registration form, together with the associated waiver of responsibility. When using the online registration form below, please note your team association in parenthesis after your last name.

Online Registration Form

Type of Registration (check one): Pre-Registered (I have mailed, phoned, faxed, or emailed my registration prior to today) Initial Registration (this is my only registration for the Walkathon) Donation Only (I am making a donation only I will not walk)
First Name
Last Name
Address
City, State Zip	,
Day Phone
Evening Phone
Email
Your confirmation and walkathon information will be sent to the email address you enter above
How did you hear about the NAMI walk? Picked up a brochure NAMI web site Radio Station For this option, please enter the radio station's call letters: Friend or Family Other please identify:
Waiver of responsibility: Waiver of Responsibility: In signing this waiver and release, I acknowledge that I understand its intent, and I for myself, my heirs, executors, administrators and representatives, do hereby agree and will absolve and hold harmless the National Alliance for the Mentally Ill, the NAMI McHenry County chapter, corporate sponsors, cooperating organizations and any other parties connected with this event in any way, together with their respective successors, and assigns (the Sponsors) singly and collectively, from and against any blame whatsoever, which may result from or be connected in any way to my participation in the NAMI McHenry County chapter walk. In addition to the absolute and unqualified release from all liability, I hereby represent that I am physically capable of participation in this event, and I will observe all applicable traffic and event rules, and that I will conduct myself in a safe and prudent manner while participating in the event and I hereby absolve and hold harmless the Sponsors from any damage I may sustain because of any breach of these representations. I understand that the National Alliance for the Mentally Ill, and the NAMI McHenry County chapter, reserves the right to refuse or dismiss anyone that may cause any disturbance or hindrance in any manner that could jeopardize the success of the walk. I hereby consent to and permit emergency treatment in the event of injury or illness while participating in this event. I also give permission to the National Alliance for the Mentally Ill, and the NAMI McHenry County chapter to use my name and any photography taken of me during the event in any promotional materials.
I certify that by clicking submit below I am submitting my registration for the Walkathon and have read the waiver and release above and understand its significance.

Note: Some computers or software may be incompatible with online registration. If you receive an error message page instead of a registration confirmation page after submitting your registration, either download the Walkathon Individual Registration Form found on the Walkathon Downloads page and mail to NAMI-MC, 333 Commerce Drive, Suite 900A, Crystal Lake, IL 60012, or register the day of the walk.