Walk Registration Form — Brain Tumour Support

Register to Walk with Kate

To register to Walk With Kate and help fundraise for Brain Tumour Support NZ, please fill out this form and submit. Thank you!

Team Name / Nickname

Choose a fundraising name for display on our Leaderboard (optional)

Name

First Name

Last Name

Email

Address

Please tell us where you wish your fundraising pack to be posted

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Sponsored Miniwalk

Please indicate which Sponsored Miniwalk you wish to undertake (dates and times are subject to change)

Miniwalk Wellington - Saturday 12 December 2020 at 2.00pm

I'm arranging my own sponsored walk (see below)

If arranging your own sponsored walk, please describe your route and date below

Number of walkers

How many people will be walking in your team?

Tell us about yourself and why you are walking with Kate

(Optional)

Do you wish to subscribe to news and updates from Brain Tumour Support NZ?

Yes, please

No, thanks

Disclaimer

Please ensure that you and everyone in your Team have the required fitness level to safely undertake your chosen walk. By registering to take part in this event, participants agree to assume all risk involved by participating in the event, including any and all liability for personal injuries (including death) and property losses or damage occasioned by, or in connection with any activity relating to said event, including travel. Participants also agree to release from liability and to indemnify and hold harmless Brain Tumour Support NZ, Beating The Track For Brain Cancer, their agents, employees, volunteers and trustees.