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ANCOP Walk Participant Registration - ( Montreal )

Step 2

Thank you for registering early!

The early registration fee is: $20.00
Early Registration ends: Wednesday, July 31, 2013 - 11:59:59 PM Eastern Std. Time

Please provide us with the following information

Fields marked with a * are required.

First name

 *

Last name

 *

Suite / Apt. #:

Address:

 *

City

 *

Province

  *

Postal Code

 * e.g. M6K3E3

Telephone

  * -   *  ext. 
e.g. 416 - 1234567 ext. 777

E-mail Address

 *

Re-type E-mail

 *

T-Shirt Size:    *

Please select a desired t-shirt size above.
T-shirts are standard sizes only.


Account Information

Username

  *  

(25 character limit)
Hint: your username and password will be
sent to you in a confirmation email after
you register.

Password

  *  

Hint: Your password must be at least 5
characters. Choose something easy to
remember, preferably a combination of
letters and numbers.

Re-type Password

  

Fund Raising Goals

Your fundraising goal can help you focus your fundraising efforts and will encourage others to help you reach it. We encourage you to set a goal for each. You will be able to track your donations on your personal ANCOP Walk homepage.

My Shelter Fund Raising Goal   $ *

My Child Education Fund Raising Goal   $ *

Personal Information

Donors can search for participants on the website to donate to them. By clicking 'yes' your friends and family will be able to find your name on our website and donate to you. Would you like your name included in the website search feature?

Yes, include my name in the participant search.
No, do not include my name in the participant search.


Use of Personal Information

I consent to the collection, use and disclosure of all information collected on this
      site by the ANCOP Walk ANCOP International Canada employees, Team Captains,
      organizational representatives and agents only for the purposes of future
      contact, statistical purposes and processing of my entry and donations.

I do not , wish to be contacted by ANCOP Walk / ANCOP International Canada


Waiver Acceptance

In consideration of accepting this entry, and granting of the right to participate, I the undersign, intending to be legally bound, hereby, for myself, my heirs, personal representative, successors, and assigns, hereby release, waive and forever discharge any and all claims for losses and damages I may have against the Event Committee, ANCOP International Canada, Event Volunteers, Event Sponsors, city Government hosting this event, City and State Police, their representatives, successors and assigns and/or any other person whomsoever, for any and all injuries, illnesses, including death, that may result from my participation in this event. I represent and affirm that I am in proper physical condition to participate in this event and have sufficiently trained for the completion of this event. I also understand that any sponsor may use my name and/or pictures taken during this event for publicity of the ANCOP Walk and/or ANCOP International Canada, without obligation or liability to me. By submitting this entry, I acknowledge having read, understood and agree to the above waiver, release and indemnity.

I agree with and accept the terms of the waiver.

ANCOP International Canada is a registered non-profit charity that provides Child Education Sponsorships and Shelter/Housing Programs for the poor. To learn more please visit our website at www.ancop.ca