HACCM OPA VOLTA 5K WALK-A-THON 2023 HACCM OPA VOLTA 5KWALK-A-THON – SATURDAY, AUGUST 19, 2023WALK-A-THON STARTS AT 8:30 a.m. FROM 3131 N.E. GLISAN ST. PORTLAND, OR Participant Walk-a-Thon Registration Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email (If participant is a minor, enter legal guardian’s email)(Required) Phone(Required)ASSUMPTION OF RISK, RELEASE AND PERMISSION: Walk to support Hellenic-American Cultural Center & Museum (HACCM) involves walking – an activity which may include risks such as, but not limited to, falls, interaction with other participants, effects of weather, traffic and conditions of the road. In consideration of being allowed to participate in this event, I hereby expressly assume all risks, including bodily and personal injury, death, property loss or other damages of any kind arising in any way out of my attendance or participation in the HACCM and the City of Portland its officers, agents and employees and related activities. It is my responsibility to dress appropriately. Although route maps, rest stops, refreshments, and other assistance may be made available during this event, I am solely responsible for my own health and safety. I represent that I am physically fit and able to attend or participate in this event. I hereby for myself, my heirs, executors and administrators, release, discharge and agree not to sue HACCM, their respective officers, directors, volunteers, employees, sponsors and agents, from any and all liability, claims, demands and causes of action whatsoever, arising out of my participation in or attendance at this event and related activities whether resulting from the negligence of any of the above or from any other cause. I agree that my assumption of risk and release hereunder shall be as broad and inclusive as is permitted under applicable law. If any portion of this agreement is held invalid, the remainder shall continue in full force and effect. I grant full permission in perpetuity to the organizers of this event to use, re-use, publish and re-publish my name and image as a participant in the event in photographs, video or other recordings. HACCM is committed to providing an environment free from harassment and discrimination. HACCM strictly prohibits harassment and discrimination based on race; creed; color; religion; gender; sex; sexual orientation; national origin; ancestry; age; veteran status; citizenship status; marital status; physical or mental disabilities; pregnancy, gender identity or expression (including transgender status); and genetic information and any other characteristic protected by federal, state or local law. I have read, understand and agree to the terms of this agreement. If Participant is a minor, the parent or guardian must agree to the below: I am the legal guardian of Participant, and I hereby consent to his/her participation. I have read the foregoing agreement, and I hereby agree on behalf of myself and Participant to its terms. Consent(Required) Yes, I agree to the terms and conditions.Consent If Participant is a minor, the parent or guardian must agree to the below:I am the legal guardian of Participant, and I hereby consent to his/her participation. I have read the foregoing agreement, and I hereby agree on behalf of myself and Participant to its terms.Legal guardian’s name First Last Legal guardian’s digital signatureDate MM slash DD slash YYYY Emergency Contact(Required) First Last Emergency Phone Number(Required)HACCM WALK-A-THON Registration Price: $25.00 Total Credit CardCAPTCHA Δ