NEDA Walk Registration Form

Nearly 10 million women and

1 million men suffer from anorexia

and bulimia; many millions more

from binge eating disorder.

Walk with NEDA to help battlethese debilitating illinesses.

Simply register and ask your friends

and family to support your efforts.

NationalEatingDisorders.org

until eating disorders are history

Nearly 10 million women and one million men in the U.S. suffer from anorexia and bulimia; many millions more from binge eating disorder.

Anorexia nervosa has the highest premature fatality rate of any mental illness • (Sullivan, 1995).

The majority of people with severe eating disorders do not receive adequate care.•

Four out of ten Americans either suffered or have known someone who has suffered from • an eating disorder.

Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight • control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (Neumark-Sztainer, 2005).

In the United States, eating disorders are more common than Alzheimer’s disease. Despite its • prevalence, there is inadequate access to quality treatment, insurance coverage, and research funding for eating disorders — approximately 75% less funding than that for Alzheimer’s.

Although recovery from anorexia nervosa is often protracted nearly a decade, the outcome • of treatment is better than for obesity or breast cancer.

In 1999, NEDA established a toll-free helpline and has assisted more than 50,000 people find appropriate treatment. Tallying more than 50 million web hits each year, NEDA is proud to serve as a clearinghouse of information on eating disorders.

About Eating Disorders

NEDA supports individuals and families affected by eating disorders, and serves as a catalyst for prevention, cures and access to quality care.

Sponsor Name Address Contribution I would like more info about NEDA

1. Yes No

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3. Yes No

4. Yes No

5. Yes No

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9. Yes No

10. Yes No

11. Yes No

12. Yes No

13. Yes No

14. Yes No

15. Yes No

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18. Yes No

19. Yes No

20. Yes No

Total Funds Raised:

Please complete and mail to the return address provided for the NEDA Walk Coordinator. Please print clearly. Thank you.

WALK LOCATION

NAME

ADDRESS

CITY STATE ZIP

PHONE E-MAIL ADDRESS

I have read and fully understand the above. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.

Participant represents that she/he is executing this agreement voluntarily.

Thank you for participating in the 2008 NEDA Walk (“Event”). Please read this form carefully and be aware that in signing up and participating in this Event, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss, including death, which you or your child might sustain as a result of participating in any and all activities connected with and associated with the Event.

NEDA is committed to conducting its programs and activities in a safe manner and holds the safety of participants in high regard. NEDA also strives to reduce the risks of the Event and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, you must recognize that there is an inherent risk of injury when choosing to participate in these types of events. You (the “Participant”) are solely responsible for determining if you or your child is physically fi t and/or adequately skilled to participate in the Event. It is always advisable, especially if the Participant is pregnant, disabled in any way, or recently suffered an illness, injury, or impairment, to consult a physician before undertaking any physical activity. You are also solely responsible for selecting and wearing personal protective equipment. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of injury, including death from participating in the Event and it is impossible for NEDA to guarantee your absolute safety.

I recognize and acknowledge that there are certain risks of physical injury to participants in this Event and I voluntarily agree, as a condition of my and/or my child’s participation in the Event, to assume the full risk of any injuries, costs, damages or losses, regardless of severity, that my child or I may sustain as a result of participating in any and all activities connected with or associated with this Event. I agree to waive and relinquish all claims, specifi cally including those for any injury (including death), costs, damages and/or losses arising out of or otherwise incidental to participation in the Event, that I or my child may have as a result of participating in this activity, against NEDA including its

NEDA Walk — RELEASE AND ASSUMPTION OF RISK

offi cers, offi cials, agents, employees, representatives, volunteers and servants, (both individually and collectively). On behalf of myself and/or the child identifi ed above, I do hereby fully release and forever discharge the NEDA from and against any and all claims for injuries, damages or loss, including death, that my child or I may have arising out of, connected with, or in any way associated with this Event. This waiver and release shall apply to any and all actions, causes, damages, claims, or demands of every kind, whether known or unknown, arising out of or otherwise incidental to participation in the Event. On behalf of myself and/or the child identifi ed above, I hereby agree to indemnify, hold harmless, and defend NEDA from and against any and all liability or claims for loss, damage, or injury to person or property, or of any other kind, whether known or unknown, including your person and property and including claims for attorney’s fees, arising out of or otherwise incidental to your participation in the Event. While participating in the Event, you agree to obey all rules, regulations, and laws of the United States and the state and locality where the Event is held. You agree to obey all rules, regulations and policies of the NEDA associated with the Event. You agree that your violation of the above rules, regulations, laws or policies (as determined in the sole discretion of a NEDA representative) may result in your expulsion from the Event. I further agree that this Release will be governed by the State of Washington.

In conjunction with NEDA’s possible use of my appearance or of materials supplied by me in photos and promotional materials about the Event, NEDA may use my name, likeness, voice, biographical information and the material supplied by me (“Biographical Information”) for the purposes of advertising, publicity, fundraising and promotion associated with the Event. I understand that NEDA will own any such photos or materials from the Event that may include my Biographical Information and will have the right to use and reuse, modify, adapt and create derivative works of them.

$15 for adults $10 for kids 12 and under

Registration on day of walk is $20/adult, $10/kid

Make all checks payable to NEDA.

I do not intend to walk, but would like to volunteer.

I do not intend to walk, but a donation is enclosed.

My Registration Fee is enclosed:

Return Address for NEDA Walk:

NEDA WALK COORDINATOR NAME

ADDRESS

CITY STATE ZIP

PLEASE PRINT Participant’s Signature (18 years or older; or Parent/Guardian)

NAME

DATE

Emergency Contact Information:

NAME

PHONE

Walker Registration Form Pledge Form

Attach additional pages as necessary. This pledge form and all contributions are due on the day of the NEDA Walk. Turn your envelope in to the Walk Coordinator or the registration table.

LAST NAME FIRST NAME

ADDRESS

CITY STATE ZIP CODE

TELEPHONE E-MAIL ADDRESS

NEDA is a 501(c)(3) nonprofit and all donations are tax deductible. Please make checks payable to NEDA. Thank you!

until eating disorders are history