Online Registration Form: 2008 Bed Races: Community Events: Welcome to LGHFoundation.com

Saturday, September 20, 2008

10 a.m. to 2 p.m.

The Village at Park Royal,

West Vancouver

Info Hotline 604-984-3864
Email: info@lghfoundation.com

If you have any questions and would like more information concerning this event, please contact Kristy Gill using the contact information below:

Kristy Gill
Director, Donor Relations
Tel: 604-904-3561
Fax: 604-984-5786
Email: kristy.gill@vch.ca

Form a team of 5 people (4 runners and 1 'patient' on the bed) of your friends, family or co-workers. Select a name for your team and choose a Captain. Each participant is required to complete a registration form. Registration deadline is Friday, September 5, 2008. All completed registration forms and fees to be submitted either through this online form, by mail or by fax.

Required information is marked by an asterisk *.

Are you a Team Captain:

I am a Team Captain (Please check if yes)

*Team Category:

Open

Corporate

Masters (50 years & over)

Youth (18 years & under)

Participant Contact Information:

*Team Name:

Company Name: (if applicable)

*First Name:

*Last Name:

*Home Address:

*City:

*Postal Code:

*Phone (h):

Phone (w):

Fax:

Email:

Gender:
Female Male

*Adult T-Shirt Size:
X-Small Small Medium Large
X-Large XX-Large
*Age Group:

13 years & under 14-18 19-29 30-39
40-49 50 years & over
*Registration Fees:

Category
Fee

Adult $25

Youth $15

Fees include a limited edition T-shirt. (Late registrants will receive their T-shirt after event day).

*Payment Method:

Cheque (make payable to: Lions Gate Hospital Foundation)
Visa
MasterCard
Card Number:

Expiry Date:

Cardholder's name:

*Release of Liability and Waiver:

Lions Gate Hospital Foundation Bed Races Release: In signing this release I (we) acknowledge that I (we) understand the intent thereof, and I (we) hereby agree to absolve and hold harmless the Park Royal Shopping Center Holdings, Lions Gate Hospital, sponsors, cooperating organizations and any other parties connected with this event in any way, singly or collectively, from and against any blame of liability for injury, misadventure, harm, loss, inconvenience or damage hereby suffered or sustained as a result of participation in Lions Gate Hospital Foundation's Bed Races event on September 20, 2008 and any activities associated herewith. I (we) hereby consent to and permit emergency treatment in the event of injury or illness, I (we) also give full permission for use of my (our) name and photograph in connection with this event.

I agree to the terms and conditions stated in the above release of liability and waiver.

Participant Signature:

Date:

Parent/Guardian: (If under 18 years)

Date:

Submitting By Mail or Fax

To submit credit card and/or cheques by mail or fax, please print this form and complete as required and mail to:
Lions Gate Hospital Foundation
231 East 15th Street,
North Vancouver, BC, V7L 2L7 Canada
Or fax to (604) 984-5786
Submitting Online

All your submitted information is encrypted when you submit an online registration on the Lions Gate Hospital Foundation website. Credit card transactions are securely handled by Foundation staff. We do not store any credit card information on the Lions Gate Hospital Foundation web site.

Lions Gate Hospital Foundation
231 East 15th Street, North Vancouver, BC., Canada, V7L 2L7
Phone: 604-984-5785 Fax: 604-984-5786 Email: info@lghfoundation.com