Event Location: Enter the city (e.g. Las Vegas. Little Rock, Spartanburg) and state (e.g. NV, AR, SC) where your Walk event is expected to take place.

Event Date: Choose the date on which your Walk event will be held from the menu.

*Note: Please contact the National Office at 352-332-9100 to confirm that your alternate date is approved before selecting an "Other Approved Date."

Presenting Sponsor/Facilitating Member Information: Provide contact information for the presenting sponsor/facilitating member. The email address must be entered twice to confirm that it is accurate.

*Note: The presenting sponsor/facilitating member must be an ASMBS or OAC member.

Walk from Obesity 2010 Event Agreement

1. By checking the box below, I agree to co-facilitate with others in my area that wish to participate (within a 30 mile radius) in the Walk from Obesity 2010 event.
2. I understand that I (or other co-leaders) may not use the Walk from Obesity event to promote any individual practice, service or hospital program.
3. I agree that the purpose of the event is to raise community awareness of the disease of obesity, and to raise funds for prevention, education, research and treatment of obesity; and as such, I agree to incorporate all of those who have an interest in helping people fight the disease of obesity.
4. I understand and agree that as a participant in this non-profit event, I may not, nor many any individual person, vendor, sponsor, hospital program medical practice, or other entity sell any product, goods, or services at the Walk from Obesity Event. I understand and agree to enforce this no-sales policy as to not endanger the 501(c)(3) status of the ASMBS Foundation and/or the Obesity Action Coalition.
5. I agree to completely follow all guidelines, policies, procedures and standards set forth in the official Event Committee Guide and all other instructions provided by the ASMBS Foundation and/or Obesity Action Coalition Board of Directors and Staff.
6. I agree to put any request(s) for guideline changes and/or special permission(s) in writing directly to the ASMBS Foundation office for review and consideration.
7. I agree to work with all National Event Sponsors as outlined in the National Event Committee Guide.
8. If my application is approved, I agree to pay a non-refundable site registration fee of $500 by the registration fee deadline (an invoice will be provided). I understand that if my walk has a co-facilitator (or multiple co-facilitators), the fee may be divided among the group.