Zumbathon Registration Form

Sign in here to save your spot for Vermont’s biggest Zumba® Fitness party fundraiser!

This amazing, booty shaking extravaganza will take place Saturday, March 24, 2012 at Memorial Auditorium in Burlington, VT. Check-in: 8:00-8:45am, then we Zumba® with all of your favorite local instructors from 9:00-11:30am. Thank you speech and prizes to follow.

* Name:

* Address 1:

Address 2:

City:

State:

Zip:

Phone:

* Email Address:

Please check “yes” to indicate you have read, understand and agree to the below waiver.

In consideration for the acceptance as a participant in the above entitled event, and with the understanding that my participation in this event is only on condition that I enter into this agreement for myself, I hereby assume the inherent risks involved in this event and any risks inherent in any other activities connected with this event in which I may voluntarily participate. I expressly assume the risk of and accept full responsibility for any and all injuries which may occur as result of my participation in this event and release from liability Women Helping Battered Women, Inc. and each of their officers, directors, agents, representatives, employees and members. I certify that I am over the age of 18. If under the age of 18, guardian approval required; please bring printed waiver with parent or guardian signature to door.

Yes, I have read and agree with the above statement. (Please check).

We look forward to seeing you at the event! Wepaaa!

Please contact Bridget or Shannon with any questions:
Shannon Stem: shannonstem@gmail.com
Bridget O’Connor: spacefox71@hotmail.com

Please check out our sponsors and let them know you appreciate them helping to make this event possible. We really couldn’t do it without them!

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