CCWAA September 18th & 25th, 2021

The Conquer Chiari Walk Across America is an annual fundraising and awareness event comprised of a series of local walks held on the 3rd and 4th Saturday of September.

"Walk Anywhere"

The 'Walk Anywhere' feature is a way for people who can not participate at one of the organized walk sites to get involved. By registering, you will be given a personal fundraising page which can be used to raise money and spread awareness. Walk Anywhere participants who donate or raise $40 or more by the deadline will have a specially designed T-shirt mailed to them. In addition, any individuals or teams who raise more than $1,000 will be named at the entrance of the Conquer Chiari Research Center. You do NOT have to actually walk on the day of the event, but if you choose to walk through your neighborhood or local park to raise awareness, please be aware you are solely responsible for your own activity.

Individual Registration

* - required field

Walk Location *
Team *
First Name *
Last Name *

If making a credit card donation, please use the address associated with the credit card.

Address *
City *
State *
Zip Code *
Email *
T-Shirt Size *
Donations of $40 or more. Must register prior to 8/17 to receive a shirt. T-shirt Guidelines

Fundraising Page Information

Select Password *
Confirm password *
Fundraising Goal *

Donation Information

Registration is free, however a $40 donation is suggested.

If not donating at this time, please skip to Waiver and Release and click Continue.

Donation Amount
Card Type
Card Name
 
Credit Card #
Card Verification #
Expiration
 

Waiver and Release

Walkers 18 Years of Age and Older

In consideration for participating in the Walk Across America, I acknowledge that I am an adult of at least 18 years of age. As such an adult, I knowingly and freely assume all such risks of the Walk, both known and unknown, and assume full responsibility for my participation in this volunteer activity. For myself and on behalf of my heirs, assigns, personal representatives and next of kin, I hereby release, indemnify and hold harmless C&S Patient Education Foundation, its Board of Directors, officers, officials, agents, employees, other volunteers, sponsoring agencies, sponsors, and advertisers with respect to any and all injury, death, loss or damage to property or person associated with my presence or participation in the Walk, whether arising from the negligence of C&S Patient Education Foundation or otherwise, to the fullest extent permitted by law. By checking the box, I also agree that I have read and understand the additional COVID-19 ASSUMPTION OF THE RISK AND WAIVER.

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (under age 18 at time of registration)

This is to certify that I, as parent/guardian with legal responsibility for this minor child, do consent and agree to this release as provided above of C&S Patient Education Foundation and for myself, my child and our heirs, assigns and next of kin, I release and agree to indemnify and hold harmless C&S Patient Education Foundation from any and all liabilities incident to my child's involvement and participation in this Walk as provided above, even if arising from the negligence of C&S Patient Education Foundation or otherwise, to the fullest extent permitted by law. By checking the box, I also agree that I have read and understand the additional COVID-19 ASSUMPTION OF THE RISK AND WAIVER.

Thanks for your support!
Rick Labuda, Executive Director
director@conquerchiari.org
724-940-0116