QLife Virtual 5K Walk/Run/Roll Registration
Haga clic aquí para registrarse en la 5to caminata/carrera/roll 5k virtual de QLife
Are you a:
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Employee
Spouse of an employee
Family/Friend of an employee
Name
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First Name
Last Name
Date of Birth
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-
Month
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Day
Year
Date
Employee ID
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If you know your spouses employee ID, enter it here for credit towards QLife Rewards $250 Incentive:
What state do you live in?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Conneticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
North Carolina
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Dakota
South Carolina
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Preferred contact method:
Email
Phone
Email
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example@example.com
Phone Number
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Area Code
Phone Number
I donated to the Hunger Task Force (Optional)
Yes
No
I prefer not to answer
I donated to Feeding America (Optional)
Yes
No
I prefer not to answer
Please note the dollar amount you donated to the Hunger Task Force
Please note the dollar amount you donated to Feeding America
As a registered participant, you will receive weekly tips and resources! Let us know what you are most interested in
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General preparation tips
Advanced tips and challenges
No, thank you - I am not interested in receiving tips
QLife Virtual 5K Release
By signing below, I agree to all terms and conditions o fthis QLife Virtual 5K Release (the “Release”): I agree that I am voluntarily and freely participating in the QLife Virtual 5K (the “Activity”) which will occur at a location of my choosing. I understand that the Activity is a sporting event that involves walking, running, other ordinary activities involved in walking and running, and waiting for or spectating all of these activities. I understand that the Activity may be physically demanding and potentially dangerous. I understand that my participation in the Activity may involve risks, dangers, and hazards that may cause serious personal injury, disability and/or death and that injuries are a common and ordinary occurrence. Injuries include, but not limited to, muscle or tendon soreness or injuries, ligament or skeletal injuries, bruising or cuts, fractured or broken bones, difficult breathing or worsening of asthma or other respiratory disorder, head injuries, heart attack, and/or death. I have determined that I am physically fit and am able to participate in the Activity. I acknowledge Quad/Graphics, Inc., its subsidiaries and affiliates (collectively, “Quad”) will not make any determination regarding my ability or fitness to participate in the Activity. I have consulted with a physician, if I determined that it was necessary, to ensure that I am able to participate in the Activity. I acknowledge that Quad has not made any representation about the safety of the Activity. I understand that I may choose not to participate in the Activity or any specific aspect of the Activity. If I am experiencing a medical emergency, I will call 911.I expressly, willingly, and voluntarily accept and assume full and sole responsibility for the risks involved with my participation in the Activity, including the risk of injury, harm, or death, whether caused by my own or any other person or entity’s actions, negligence, or intentional conduct. I expressly, willingly, and voluntarily release Quad and its employees, shareholders, directors, trustees, managers, officers, administrators, partners, agents, representatives, contractors, subcontractors, successors, heirs, assigns, affiliates, and representatives from, and hold them harmless for, any and all liability, claims, rights, demands, or causes of action, known or unknown, based on my participation in the Activity. I understand that signing this Release, or a release in a form I propose that is acceptable to both Quad and myself, is a requirement to participate in the Activity. This Release shall remain in force and effect unless and until I provide written revocation to Quad at the address above. If I revoke this Release, I understand that I must immediately stop any further participation in the Activity. Electronic Signature I agree and acknowledge that I am asked to sign this Release with an electronic signature. I have read the following carefully regarding the electronic signature process. To sign this Release electronically, I have been required to: Access JotForm and the specific registration form for the Virtual 5K; Enter my first and last name; Enter my Employee ID or the Employee ID of the employee to whom I am related; Review this Release; and Click the box at the bottom of this document where it states “Submit”. I understand that my electronic signature will not be applied to this Release until I correctly complete all of these steps. I understand that I will have access to this Release to download or print. Once the signature process is completed, my electronic signature will be binding as if I had physically signed the document by hand.BY SIGNING BELOW, I AGREE THAT I HAVE READ THIS RELEASE, FULLYUNDERSTAND ALL OF ITS TERMS, AND AGREE TO THE RELEASE OF MY OWN FREE WILLINTENDING TO BE LEGALLY BOUND BY ITS TERMS AND CONDITIONS. IF I AM UNDER18 YEARS OF AGE, MY PARENT OR GUARDIAN IS CONSENTING AND GIVING PERMISSION FORMY PARTICIPATION IN THE ACTIVITY BY SIGNING THIS RELEASE ON MY BEHALF.
Signature
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Submit
Should be Empty: