The Susan G. Komen Dallas County Affiliate: Survey - 2010 Group Captain Race Volunteer Registration

2010 Group Captain Race Volunteer Registration

Please fill in the blanks with your most current contact information.

If you have previously registered, please to prepopulate your information.

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Name:

Title	First Required	Middle Required	Last Required	Suffix	Professional Suffix

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Email: Required

Street 1:

Apt #/Care of:

City/State/ZIP:

City	State	ZIP

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Phone Number: Required

Gender:

Yes, I would like to receive e-mail from The Susan G. Komen Dallas County Affiliate

Email Format:

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Question - Required - Are you the group leader?

* If you are not the leader of your group please ask your group captain to register here. You will register on a separate form with your group leader.

* If you are not part of a group of 5 or more please cancel this registration and select the individual volunteer registration form.

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Question - Required - What is the name of your volunteer group, company, school or affiliation?

Question - Not Required - Estimated number of race day volunteer participants in your group:

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Question - Required - Please select the primary age group that best describes your group of volunteers. under 9
9-15
16-19
20-50
51+

Question - Not Required - To keep costs down, I will decline receiving a new volunteer shirt this year, and wear one from a previous year.

Question - Not Required - Will the participants in your group be minors?

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Question - Required - We can use volunteers with prior volunteer experience and without. Please tell us how much prior Race volunteer experience you've had.

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Question - Required - Some volunteer assignments will require a pre-race day 45 minute to 1 hour orientation session. Will you try to make yourself available if your assignment has a pre-race training?

Question - Not Required - Are you available to volunteer during the day Wednesday, Thursday or Friday the week of the Race (Oct 13-15)?

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Question - Required - I wish to volunteer for the Dallas County Affiliate of the Susan G. Komen Breast Cancer Foundation, Inc. (the "Komen Affiliate"). I understand that the nature of volunteer activities that I may perform in my capacity as a volunteer may involve physical activity, contact with unidentified and/or unfamiliar persons, or other potential risk of bodily injury or damage to property. Knowing this and in consideration of being allowed to volunteer, I hereby assume full and complete responsibility for any personal injury and/or property damage that I sustain or cause during my participation as a volunteer. In addition, I hereby release, hold harmless and covenant not to file suit against the Komen Affiliate, the Susan G. Komen Breast Cancer Foundation, Inc. (the "Foundation") and any of their employees, volunteers, partners, agents, sponsors, board members and successors from any and all loss, liability or claims I may have arising out of my service as a volunteer.