2023 Walk a Mile in Her Shoes Registration and Liability Waiver
October 11, 2023 - 4:30 p.m.; Registration - 4:00 p.m.
Indiana University East - Quad - 2325 Chester Boulevard, Richmond, IN 47374
Questions? Contact Tracy Amyx, IU East Interim Deputy Sexual Misconduct & Title IX Coordinator:
trramyx@iue.edu | 765-973-8232
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Email *
Participant Name *
Address *
Phone Number *
Are you participating with a team or as an individual? *
If you are participating with a team, please provide the team name below.
I agree to waive, release and discharge for myself and my heirs all claims for damages against The Trustees of Indiana University on behalf of Indiana University East, and any and all sponsors, employees, representatives and event officials, for any and all injuries resulting from my participation in this event. I assume all risks associated with any voluntary participation in this event. I verify and attest that, to the best of my knowledge, I am physically fit and sufficiently trained for this event. (Parent/Guardian if under 18 years of age).  Participants must agree to this waiver statement in order to walk in the event. *
Required
Date *
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A copy of your responses will be emailed to the address you provided.
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