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The Chiropractic Joint "Correction Is What We Do" 1800 S. Milton Rd. Suite 14, Flagstaff, AZ 86001 MAP Ph. 928.774.0026

Join us as we support families with Juvenile Diabetes! In addition to the climb, we are hosting a fundraising luncheon at Hilton Garden Inn with food provided by Coco's Resturant and Bakery!  When: September 17th, 2011 at 8 am. Luncheon Starts at Around 1:00 pm Where: We will meet at Mount Elden Parking lot. Luncheon at Hilton Garden Inn. Why: Be active and help support Diabetes research! Cost: $40 for the climb. Lunch provided by Coco's. The event also includes a T-shirt. All proceeds go to JDRF. Join Us Here or see us at the office. *Since this is a charity event there will be no refunds. For more info please call (928) 774-0026 Proceeds will go to: Juvenile Diabetes Research Foundation International Things YOU MUST Bring With  You: Camelback filled with WATER Snacks – Trail Mix, Granola bars, Fruit such as oranges or bananas Good Running or Hiking SHOES- Important Light Sweat Shirt If you are Diabetic- brings sweets- Hard Candy will do All Natural Sunscreen Recommended but not needed: Hiking Stick may be used Camera- Beautiful Views Hat Sunglasses

First Name Last Name E-mail Phone Number Payment Credit Card # $40 Donation Donate More Exp. Date 3 digit v Code Shirt Size X- Large Large Medium Small By clicking on send I acknowledge the release and waiver of liability agreement. The Chiropractic Joint 3rd Annual " Climb to the Peak" RELEASE AND WAIVER OF LIABILITY AGREEMENT I, (Participant), acknowledge that I am voluntarily participating in The Chiropractic Joint, LLC, 3rd Annual Climb to the Peak. I AM AWARE THAT THIS ACTIVITY CAN BE HAZARDOUS AND THAT I COULD BE SERIOUSLY INJURED OR MAY CAUSE DEATH. I AM VOLUNTARILY PARTICIPATING IN THIS CLIMB WITH KNOWLEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. As consideration for participating in The Chiropractic Joint 3rd Annual Climb To The Peak, I forever release The Chiropractic Joint, LLC, owner, and employees, from any and all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) my participation in this activity, (ii) the negligence or other acts, whether directly connected to this activity or not, and however caused, by any Releasee, or (iii) the condition of the premises where these activities occur, whether or not I am then participating in the activity. I also agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE CHIROPRACTIC JOINT LLC, AND CLICKED ON SEND OF MY OWN FREE WILL. If SEND by Parent or Guardian: I verify that the dangers of this activity and the significance of this Release and Waiver were explained to the Participant and that the Participant understood them.