Lupus Walk 2007

5th Annual Lupus Walk - Registration
Saturday, July 14, 2007
Registration: 10:00 am
Walk Begins: 11:00 am
Refreshments after walk
Registration: By mail or online at
www.latreesefagan.org
Phone: (313) 531-9922 or Toll (866) 350-9922
Fax: (313) 531-9926
E-Mail: info@latreesefagan.org
Checks or Money Orders payable to: LNFMSF, Inc.
LNFMSF, Inc., P. O. Box 19370, Detroit, MI 48219-0370
(WALK—1 ½ Mile)
        Location: ”INGLENOOK PARK”
        20901 W. 12 Mile Rd.
        (between Evergreen & Lahser)
        Southfield, MI 48076
$15,000 FUNDRAISING GOAL
LNFMSF, Inc., is an IRS Code 501 © (3)
tax exempt organization.
2007 LNFMSF, INC., LUPUS WALK REGISTRATION FORM

If you are under the age of 18 your parent or guardian must also register and sign Waiver/Release.

Team Captains must have 4 or more Walkers to form a Team

All fields marked with a * are required:

Name of Team Captain (Optional)
Name of Walk Team (Optional)
Fundraising Goal
Name*
Phone*
Sex* Male
Female
Address*
City*
State*
Zip*
Email*
I certify that I am in good physical condition for this event*
Date*
Signed*

Are you under 18?*
If you are under 18, your Parent/Guardian must fill out the fields below:
Name*
Address*
City*
State*
Zip*
Email*
Date*
Signed*

By checking this box, I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event and in good physical condition. I know that this event is a potentially hazardous activity and I hereby assume full and complete responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event. I hereby release and hold harmless and covenant not to file suit against Latreese Nicole Fagan Memorial Scholarship Fund, Inc. organization, LNFMSF Directors and Officers, LNFMSF volunteers, fitness experts, guest speakers, walk sponsors and their agents, City of Southfield, County of Oakland, Southfield Parks and Recreation and their agents and all other persons or entities associated with this event (the “releases”) from any loss, liability, claims I may have arising out of my participation in this event , including personal injury or damage suffered by me or others, whether same be caused by falls, contact with participants, conditions of the route, negligence of the releases or otherwise. If I do not follow all the rules of this event, I understand that I may be removed from the walk. I give my full permission to Latreese Nicole Fagan Memorial Scholarship Fund, Inc., and their sponsors to use any photograph, videotapes or other recordings of me that are made during the course of this event.

All walkers/participants and parents or guardians of walkers/participants under 18 that are participating in this event must sign a waiver/release form and consent to all the provisions aforementioned above that is given in consideration of the acceptance of this registration.



Latreese Nicole Fagan Memorial Scholarship Fund, Inc. is a non profit organization.
Proceeds benefit young adults who are diagnosed with lupus. Donations are tax deductible.


Be sure to print out the proper forms below after submitting your registration.

Click to Download and Print - "Lupus Walkers" Pledge Sheet (PDF)



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