WCRC

Women's Cancer Resource Center Logo

REGISTRATION FORM

Join us for the 25th annual Swim A Mile / Move A Mile to benefit the clients of the Women's Cancer Resource Center in Berkeley, CA.

Registration fee: $25

One Registration Per Form

First Name

Last Name

Mobile Number

Address

City

State

Zip

How Would you Like to Participate?

Whether you choose your own adventure or are waiting to hear from us about swimming at the pool or walking, biking or jogging on the Mills campus, please get started with your fundraising right away. This event raises 1/3 of WCRC's annual budget, and our clients are relying on you!

Are you a child (under 18) or adult?

T-Shirt:

T-shirts ordered before September 11th will be distributed on October 24th. T-shirts ordered after September 11th will be sent to production the week of October 24th.

Would you like a commemorative medal?

How did you hear about Swim A Mile?

If you are a cancer survivor, do you want to be acknowledged as such?

May we contact you about sharing on social media your reasons for participating?

Do you want to create or join a team? That happens after you submit payment and continue on to the next step, signing up to be a fundraiser.

Tribute

Write a message here for our virtual tribute wall:

255 character limit

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I need more space for my message

If you run out of room, please email [email protected] with your additional text.

Waivers and Releases

I have read and fully understand the I have read and filled out the linked waiver and release for Mills College.

If I / my child become unable to participate, I will notify [email protected] immediately and will still meet my fundraising commitment.

I understand that the minimum fundraising obligation is $250 for adults, even if circumstances prevent me from participating. I agree to donate the difference if I do not reach my goal.

I understand that I / my child, the undersigned participant, intending to be legally bound, hereby certify that I am / my child is physically fit and have not been otherwise informed by a physician.

I acknowledge that I am aware of all the risks inherent in physical activity and the use of this facility, including possible permanent disability or death, and agree to assume all of those risks. I authorize necessary medical treatment of myself / my child in the event of sickness, accident, or injury. On behalf of myself or my child or guest, I agree to indemnify and release the WCRC and Mills College, their boards of trustees, officers, volunteers, agents, employees, and all sponsors from all liability, claims, damages, actions, related costs, and expenses (including reasonable attorney's fees) that may arise out of my participation or participation by my child or guest in this activity.

By checking this box, I hereby agree to obey all the rules, policies, and the Code of Conduct of Mills College.

I will obey all directions given by the TAC staff. Mills and WCRC reserve the right to refuse service to anyone. Mills College reserves the right to remove me / my child from the Trefethen Aquatic Center at any time.

By checking the box below, I also agree that photographs taken of me / my child at WCRC's Swim A Mile for Women with Cancer at the Trefethen Aquatic Center, Mills College, can can be used by WCRC to promote the center and future Swim A Mile for Women with Cancer fundraisers.

I agree that photos taken of me/ my child may be used by WCRC.

Please Consider an Additional Gift to WCRC.

Enter gift amount

Payment Information

This is a secure 256-bit SSL encrypted payment

Card Number

Expiration Date

CVV What is this?

I would like to cover the payment processing fee.

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Become a Fundraiser

After paying, please continue on to become a fundraiser.

You will be able to create your own personal fundraising page, create or join a team, and raise money to support the work that the Women's Cancer Resource Center does for those in our community.

Click "Confirm and Sign Me Up"
on the next screen to get started!