Online Registration Online Registration is open. Please fill the form below completely. 2024 Walk for the Mind Registration Name(Required) First Last Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required) Phone(Required)Waiver(Required)RELEASE AND WAIVER: In consideration of the acceptance of my entry for Mark Linder Walk for the Mind, I hereby for myself, my heirs, executors and administrators, fully and forever RELEASE, REMISE, ACQUIT AND DISCHARGE the University of Illinois Foundation, University of Illinois College of Medicine, the Peoria Park District, RiverPlex, the City of Peoria and the Mark Linder Walk for the Mind (including, but not limited to, any volunteers, organizers, agents, servants, sponsors) and each of their officers, directors, agents and employees from any and all claims, demands, damages, actions or rights of action of whatever kind or nature I may now have or may hereafter have arising out of or in consequence of all known or unknown injuries to person or damages to property resulting to me in any way from my participation in the Mark Linder Walk for the Mind. I also grant permission to all the foregoing to use any photographs, motion pictures, recordings or other records of this event for any legitimate purpose. THIS RELEASE MUST BE SIGNED TO PARTICIPATE IN THE WALK. I agree to the Waiver.Walker/ Survivor Name1(Required) Choose:(Required) Walker Survivor Select Adult/Child/Survivor1(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size1(Required)SmallMediumLargeXLNo ShirtChild Size1(Required)Medium youthNo ShirtAdult Size1-2x,3x(Required)2X3XSurvivor Adult-Child Size1(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtOnline User Fee1(Required) Price: Check to add another participant2 Check to add another participant2 Walker/Survivor Name2(Required) Choose2(Required) Walker Survivor Select Adult/Child/Survivor2(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size2(Required)SmallMediumLargeXLNo ShirtChild Size2(Required)Medium youthNo ShirtAdult Size2-2x,3x(Required)2X3XSurvivor Adult-Child Size2(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver2(Required) I agree to the waiver above. Online User Fee2(Required) Price: Check to add another participant3 Check to add another participant3 Walker/Survivor Name3(Required) Choose3(Required) Walker Survivor Select Adult/Child/Survivor3(Required)Adult S-XL- $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size3(Required)SmallMediumLargeXLNo ShirtChild Size3(Required)Medium youthNo ShirtAdult Size3-2x,3x(Required)2X3XSurvivor Adult-Child Size3(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver3(Required) I agree to the waiver above. Online User Fee3(Required) Price: Check to add another participant4 Check to add another participant4 Walker/Survivor Name4(Required) Choose4(Required) Walker Survivor Select Adult/Child/Survivor4(Required)Adult S-XL - $25Adult 2X, 3X - $28.00Child - $15Survivor - FreeAdult Size4(Required)SmallMediumLargeXL2X3XNo ShirtChild Size4(Required)Medium youthNo ShirtAdult Size4-2x,3x(Required)2X3XSurvivor Adult-Child Size4(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver4(Required) I agree to the waiver above. Online User Fee4(Required) Price: Check to add another participant5 Check to add another participant5 Walker/Survivor Name5(Required) Choose5(Required) Walker Survivor Select Adult/Child/Survivor5(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size5(Required)SmallMediumLargeXLNo ShirtChild Size5(Required)Medium youthNo ShirtAdult Size5-2x,3x(Required)2X3XSurvivor Adult-Child Size5(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver5(Required) I agree to the waiver above. Online User Fee5(Required) Price: Check to add another participant6 Check to add another participant6 Walker/Survivor Name6(Required) Choose6(Required) Walker Survivor Select Adult/Child/Survivor6(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size6(Required)SmallMediumLargeXLNo ShirtChild Size6(Required)Medium youthNo ShirtAdult Size6-2x,3x(Required)2X3XSurvivor Adult-Child Size6(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver6(Required) I agree to the waiver above. Online User Fee6(Required) Price: Check to add another participant7 Check to add another participant7 Walker/Survivor Name7(Required) Choose7(Required) Walker Survivor Select Adult/Child/Survivor7(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size7(Required)SmallMediumLargeXLNo ShirtChild Size7(Required)Medium youthNo ShirtAdult Size7-2x,3x(Required)2X3XSurvivor Adult-Child Size7(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver7(Required) I agree to the waiver above. Online User Fee7(Required) Price: Check to add another participant8 Check to add another participant8 Walker/Survivor Name8(Required) Choose8(Required) Walker Survivor Select Adult/Child/Survivor8(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size8(Required)SmallMediumLargeXLNo ShirtChild Size8(Required)Medium youthNo ShirtAdult Size8-2x,3x(Required)2X3XSurvivor Adult-Child Size8(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver8(Required) I agree to the waiver above. Online User Fee8(Required) Price: Check to add another participant9 Check to add another participant9 Walker/Survivor Name9(Required) Choose9(Required) Walker Survivor Select Adult/Child/Survivor9(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size9(Required)SmallMediumLargeXLNo ShirtChild Size9(Required)Medium youthNo ShirtAdult Size9-2x,3x(Required)2X3XSurvivor Adult-Child Size9(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver9(Required) I agree to the waiver above. Online User Fee9(Required) Price: Check to add another participant10 Check to add another participant10 Walker/Survivor Name10(Required) Choose10(Required) Walker Survivor Select Adult/Child/Survivor10(Required)Adult S-XL - $25Adult 2X, 3X - $28Child - $15Survivor - FreeAdult Size10(Required)SmallMediumLargeXLNo ShirtChild Size10(Required)Medium youthNo ShirtAdult Size10-2x,3x(Required)2X3XSurvivor Adult-Child Size10(Required)Survivor Adult SmallSurvivor Adult MediumSurvivor Adult LargeSurvivor Adult XLSurvivor Adult 2XSurvivor Adult 3XSurvivor Youth MediumNo ShirtWaiver10(Required) I agree to the waiver above. Online User Fee 10(Required) Price: Tax Information: Registration fees are not tax deductible as charitable contributions for Federal Income Tax purposes.Donations - Only donations (not registrations) are credited to a team. See list of teams at https://marklinderwalkforthemind.org/team-descriptions. Yes No Team NameOnly donations are credited to the team. See list of teams at https://marklinderwalkforthemind.org/team-descriptions. Donation Amount MessageTotal Due Credit Card(Required)Credit CardPayPal Checkout American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name