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Medical Support Personnel
   Saturday, June 8, 2013 (06:30 AM - 12:15 AM)

* Required fields

* First Name:
* Last Name:
* Address:
* City:
* State:
or * Province:
* Zip/Postal Code:
* Country:
* Gender Female Male
* Date of Birth:  
* Email :
* Home Phone:
Work Phone:
*T-shirt Size:
*In case of emergency contact
(enter as NAME : PHONE : ALT PHONE):
Comment
(eg: who you'd like to work with,
or, list second volunteer choice):
PLEASE READ AND AGREE TO WAIVER
I, the undersigned, have made an offer of my services to the Government of the United States as a volunteer for the Marine Corps Event Series-Run Amuck to be conducted during the period of June 6, 2013 to June 8, 2013 in and around the Race Site, in Marine Corps Base Quantico Virginia. This offer is made on a voluntary basis and is proposed to be at no cost to the Government, ie., without compensation; in consideration of the Government's acceptance of my offer, I hereby release and discharge for myself and, to the extent otherwise permitted by law, for my heirs and assigns, the Government of the United States from any claims, suits, or demands for compensation, which I or my heirs or assigns may have in connection with any volunteer services I perform for the Government of the United States. I understand that I am not working as, or volunteering my services as a federal employee, and I have been advised that my volunteer services will not lead to employment with the Government. I understand that I am not considered to be a "federal employee" for any purpose other than for purposes:
(1) of the Federal Tort Claims provisions publishes in 28 U.S.C. 2671 through 2680; and,
(2) of Title5 U.S.C. Chapter 81, relative to compensation for injuries sustained during the performance of work assignments.

I understand and agree to coordinate the nature, scope, and timing of my volunteer services with all appropriate persons and to follow his/her guidelines and instructions to insure such services do not interfere with mission requirements.
 

 
INFO FOR PARENT/GUARDIAN COMPLETING THIS REGISTRATION
Registration for minors must be completed by a Parent or Legal Guardian. If your age on race day is less than 18 years old, please fill in the Parent/Guardian Contact Information below. Providing such information and continuing this process indicates that this registration was completed by the person listed below.
Parent/Guardian Name:
Contact Phone:
Contact Relationship:
 
*Agree to waiver: I agree I do not agree