Register | Stead Tread 5K

09/21/2024 @ 9:00 am

Stead Tread 5K
5K Run
Solite Park

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Stead Tread 5K Registration Form

DONATIONS ALSO POSSIBLE, AT THE BOTTOM OF THIS REGISTRATION FORM!

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Categories *

5K (Ages 13 or older and not a Lincoln patient) - $35.00

5K (Lincoln patient) - No charge

5K (Ages 12 or younger) - No charge

Participant Information

Contact Email *

Participant First Name *

Participant Last Name *

Participant Birthdate *

Participant Gender *

Identifies as Male

Identifies as Female

Non-Binary

Country *

Street Address (w/Apt#) *

City *

State *

Zip Code *

Phone *

Would you like to receive important event text alerts on this number (eg. changes or delays)?

Emergency Contact Name *

Emergency Phone *

Check the box if you do not want your name on the Participant List of our website.

Adult T-Shirt Size *

Shirt Sizes are guaranteed to all entered by September 1.

Check the category that best applies to you *

Duke Internal Medicine Resident

Lincoln Patient

Housestaff not in Duke Internal Medicine program

Duke Faculty/Staff

Duke Student

Duke Advanced Practice Provider (APP)

None of the above

Duke Department and Division (e.g., Medicine-Rheumatology):

School:

If you are a member of a team (e.g. corporate sponsor or otherwise), please list the name here:

Do you want official chip timing? *

Chip timing (you will receive an official time and be eligible for time-based awards)

No chip timing (no official time, not eligible for time-based awards)

Will this be your first Stead Tread?

Yes

Check here to opt-out of post-event communication from Stead Tread and its sponsors.

Make a Donation

Lincoln Community Health Center
click here, to learn more about this cause

Amount $

Join the Eugene Stead Honor Roll: We are launching an Honor Roll to recognize the generous faculty donors who help enable a high-quality event and support our residents' participation and the Lincoln clinic! All contributions of $90 or greater will be recognized on the Eugene Stead Honor Roll on our website and at the event. All donations are tax-deductible.

Waiver *

Waiver of Liability: I intend to participate in the 2024 Stead Tread Run/Walk. I understand there may be certain dangers and exposure to physical injuries in pursuing this fund-raising effort, and I hereby voluntarily assume all risk to myself and my property arising from my participation in this event. I assume such risks regardless of their causes. In consideration of the Duke Internal Medicine Residency Program, Duke Department of Medicine, Duke School of Medicine, Duke University Medical Center, and Duke University permitting me to participate in this fund-raising effort, I will not hold the Sponsors and Contributors of this event, Young & Associates, Duke Internal Medicine Residency Program, Duke Department of Medicine, Duke School of Medicine, Duke University Medical Center, and Duke University, their trustees, officers, agents or employees, in both individual and representative capacities, liable in damages for any injuries I might sustain while getting to, during, or while leaving this activity. I release, discharge and hold forever harmless the aforementioned parties from any and all liabilities, claims, damages, or losses stemming from injury to person or property that arises from, or in any way relates to my participation in this activity.

Permission for Photographs/Video Taping: I authorize Duke to permit its representatives and/or the news media to take photographs or video tape of me or my dependent. I understand that Duke retains no control of the use of any photograph or videotape that is released to or taken by the news media. Expiration date or an expiration event: 100 years from today's date.

Permission for Release of Information for Marketing/Advertising Purposes: I authorize Duke to take photographs of me or my dependent while I (he/she) am (is) a patient for use in marketing or advertising its services. I understand that the photographs, video tape or audio tape will be used primarily for marketing or advertising purposes, such as brochures, newsletter, Duke Web site and advertising. Expiration date or an expiration event: 100 years from today's date. I understand that: If the materials are copyrighted by Duke, the material will be under the control of Duke. I understand, however, that once information and/or materials are released to the public information media including but not limited to television, newspaper, magazine, radio, and the internet Duke no longer has control over their use. I hereby release and discharge Duke as well as their assigns and/or representatives from any and all claims and demands arising out of or in connection with the use of the photographs, video tape, and audio tape. I will receive no compensation for consent for the release of this material. I have the right not to be photographed, videotaped or audio taped or have information concerning me or my dependent released to the media. This authorization may be revoked at any time. Revocation must be made in writing and sent to the appropriate news office (see contact information below). Such revocation shall not affect disclosures prior to revocation. I understand that Duke retains no control over the use of this information once it is released to the media.

I have carefully read this Release and Assumption of Risk and fully understand its contents. I voluntarily sign this agreement and realize that this will bind me, my heirs, and my personal representative. Parent or guardian must sign if participant is less than 18 years of age.;;;;;

Read through the agreement

I have read and agreed to the TERMS *

Is the participant 18 or older? *

18 or older Under 18

Payment Details

Discount or Tracking Code

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Price

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Donation

Total Owed

Payment Method

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