Walk/Bike-A-Thon Registration Form

On October 22, 2016, join T.R.U.S.T. South LA as we celebrate 10 years of community leadership and strengthening our community! With neighbors and friends, we will take to the streets on our feet and bikes to celebrate community and recreation. We will end at the T.R.U.S.T. South LA Headquarters on 43rdPlace and Main Street for a fun and family-friendly block party!

We need your participation and support! Sign-up for the Walk/Bike-A-Thon and help raise critical funds to help T.R.U.S.T. South LA continue its community-rooted work to empower leaders to reclaim land and steer our community’s future.

Distance: 2 Miles

Walk/Bike-A-Thon:

12p to 3p, starting at Rolland Curtis Garden Apartments, (Vermont Avenue & Exposition Boulevard

Block Party:

3p to 8p, 43rd Place between Broadway & Main

Participant Name: ______Team Name:______

Address:______City:______Zip Code:______

T.R.US.T. South LA Member? / Yes / No

Phone Number: ______Email ______Address:______

Agreement & Waiver

Please read the following statements carefully. In order to participate in this event, you need to sign and return the form before or at the event.

I ______assume all responsibility for any injury and destruction of property during this event. I ______am fully responsible if I ______choose to not wear a helmet, and/or use other safety precautions.

◊ If under the age of 10, I am required to be accompanied by a parent or guardian, and/or someone over the age of 16 who will be held fully responsible for any actions, injury, and overall safety.

I agree to this release of liability.

______

Print Name Signature Date

Additional Information:

Thank you for your interest in supporting the T.R.U.S.T. 10-Year Anniversary Celebration Bike/Walk-A-Thon. Please note the following information to help you complete your registration and collect pledges.

Registration: Registration starts at 12p at Rolland Curtis Gardens apartment complex located at 1077 W 38th Street (1 block East of Vermont near Exposition).Please bring a completed registration form, waiver form, pledge form and collected monies.

Team Registration: We encourage teams to show your team pride by walking and/or riding together and joining forces to raise pledges. Individual team members should complete a registration form with waiver and pledge form, and note their team name on their forms. The day of the event, teams are encouraged to wear similar T-shirts or other clothing to show their team pride!

Route: Please note the Bike/Walk-A-Thon map indicating the route for the event.

Walk/Bike-A-Thon Pledge Form Distance: 2 miles

Participant Name:______Team Name (if applicable):______

Name / Email / Address / Phone / Pledged Amount Per Mile / Total Amount
Pledged
  • Flat donation: a fixed $ amount that does not depend on the distance of the participant (Suggested minimum donation is $10.00 per mile, or $20.00 for a flat donation. Donations can be paid by cash or check. All checks should be made payable to T.R.U.S.T. South LA.Tax deductible donations (of any amount) made out to T.R.U.S.T. South LA. PLEASE RETURN SHEETS & PLEDGES to .