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Golfers Registration
   
  Name
 
    First                                            Last
   
  Address

Street Address 1
 
Street Address 2
    
    City                                                State
   
Zip Code

  Phone

  ###    -      ###    -      ###
  Email
Goal
  Waiver/Release
I hereby certify the following: (1) I am physically fit and have received, or waived medical clearance to participate in the WATAC Golf-A-Thon.  (2) In consideration of my application to participate in the WATAC Golf-A-Thon being accepted, I, on behalf of myself, my heirs and assigns, and my estate, hereby waive and forever discharge the sponsors, organizers, affiliates and their agents and employees from any and all claims that may accrue as the result of my participation.  (3) I hereby grant WATAC specific permission to reproduce, publish, circulate, copyright or otherwise use any and all photographs or videotape of me or my family, taken at the WATAC Golf-A-Thon, for use by WATAC.