Children's Heart Foundation

* Surname (Representative) :
* Given Name (Representative) :
Name of Organization :
* Tel No. :		Fax No. :
E-mail :
Total No. of Participants :	Adult : Child aged under 12 :
No. of People Taking the Free Shuttle Bus :
Mailing Address for official receipts :

	I / I and my team members, the undersigned, wish to enter Heart-to-Heart Charity Walk 2009. I / We confirm and agree that I / we shall comply with all relevant rules and regulations and other arrangements made by the organizer and I / we shall take part in the event entirely at my own risks and I / we shall not hold the organizer, any sponsors and / or supporting organizations responsible for any accident of whatever kind, resulting from death or injury, and / or for any damage or loss or destruction of personal properties during the course of the event.
	I Agree