Register for Team Gilead

Participant Name*

First Last

Select T-Shirt Size*

T-shirt pick-up options: mail your shirt or pick up*

There will be 2 packet pick ups offered at the administration building in Middletown. Dates TBD. If you prefer to have your t-shirt mailed, we can do so.

Participant Waiver*

I agree

I know that participating in an event that is organized as a virtual activity where I exercise on my own, at a date and time of my choosing, in a location of my choosing, which will not have any support or security measures in place by Gilead Community Services, Inc., is a potentially hazardous activity, which could result in injury or death. I acknowledge that I am participating in the activity by my own free will and at my own personal risk. I will not participate unless I am medically able and by my signature, I certify that I am able and in good health. I further agree to abide by the Center for Disease Control’s (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Gilead Community Services, Inc., all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this virtual event, and waive my ability to bring any legal action against the entities outlined in this waiver as I am voluntarily electing to participate on my own as part of this virtual event. I grant permission to all of the foregoing to use my photographs which I may share online as part of the event, personal data provided during registration and post-event reporting, video or audio recordings, or any other record of this event for any legitimate purpose.

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone

Additional Participants?*

Yes
No

2. Participant Name*

First Last

2. Select size*

2. T-shirt pick-up options: mail your shirt or pick up*

There will be 2 packet pick ups offered at the administration building in Middletown. Date TBD. If you prefer to have your t-shirt mailed, we can do so.

2. Participant Waiver*

I agree

I know that participating in an event that is organized as a virtual activity where I exercise on my own, at a date and time of my choosing, in a location of my choosing, which will not have any support or security measures in place by Gilead Community Services, Inc., is a potentially hazardous activity, which could result in injury or death. I acknowledge that I am participating in the activity by my own free will and at my own personal risk. I will not participate unless I am medically able and by my signature, I certify that I am able and in good health. I further agree to abide by the Center for Disease Control’s (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Gilead Community Services, Inc., all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this virtual event, and waive my ability to bring any legal action against the entities outlined in this waiver as I am voluntarily electing to participate on my own as part of this virtual event. I grant permission to all of the foregoing to use my photographs which I may share online as part of the event, personal data provided during registration and post-event reporting, video or audio recordings, or any other record of this event for any legitimate purpose.

2. Address

Same as above

2. Address

Street Address Address Line 2 City State ZIP Code

2. Email

Same as above

2. Email

2. Phone

Same as above

2. Phone

Additional Participants?*

Yes
No

3. Participant Name*

First Last

3. Select size*

3. T-shirt pick-up options: mail your shirt or pick up*

There will be 2 packet pick ups offered at the administration building in Middletown. Date TBD. If you prefer to have your t-shirt mailed, we can do so.

3. Participant Waiver*

I agree

I know that participating in an event that is organized as a virtual activity where I exercise on my own, at a date and time of my choosing, in a location of my choosing, which will not have any support or security measures in place by Gilead Community Services, Inc., is a potentially hazardous activity, which could result in injury or death. I acknowledge that I am participating in the activity by my own free will and at my own personal risk. I will not participate unless I am medically able and by my signature, I certify that I am able and in good health. I further agree to abide by the Center for Disease Control’s (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Gilead Community Services, Inc., all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this virtual event, and waive my ability to bring any legal action against the entities outlined in this waiver as I am voluntarily electing to participate on my own as part of this virtual event. I grant permission to all of the foregoing to use my photographs which I may share online as part of the event, personal data provided during registration and post-event reporting, video or audio recordings, or any other record of this event for any legitimate purpose.

3. Address

Same as above

3. Address

Street Address Address Line 2 City State ZIP Code

3. Email

Same as above

3. Email

3. Phone

Same as above

3. Phone

Additional Participants?

Yes
No

4. Participant Name

First Last

4. Select size*

4. T-shirt pick-up options: mail your shirt or pick up*

There will be 2 packet pick ups offered at the administration building in Middletown. Date TBD. If you prefer to have your t-shirt mailed, we can do so.

4. Participant Waiver*

I agree

I know that participating in an event that is organized as a virtual activity where I exercise on my own, at a date and time of my choosing, in a location of my choosing, which will not have any support or security measures in place by Gilead Community Services, Inc., is a potentially hazardous activity, which could result in injury or death. I acknowledge that I am participating in the activity by my own free will and at my own personal risk. I will not participate unless I am medically able and by my signature, I certify that I am able and in good health. I further agree to abide by the Center for Disease Control’s (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Gilead Community Services, Inc., all event sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this virtual event, and waive my ability to bring any legal action against the entities outlined in this waiver as I am voluntarily electing to participate on my own as part of this virtual event. I grant permission to all of the foregoing to use my photographs which I may share online as part of the event, personal data provided during registration and post-event reporting, video or audio recordings, or any other record of this event for any legitimate purpose.

4. Address

Same as above

4. Address

Street Address Address Line 2 City State ZIP Code

4. Email

Same as above

4. Email

4. Phone

Same as above

4. Phone

Total Participants Registered*

Please enter a number from 1 to 20.

Comments

This field is for validation purposes and should be left unchanged.

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