Form Instructions

HMSA’s go Walk@Lunch Form

To register for HMSA’s go Walk@Lunch, please print and fill out this form.

• Read the "Injury Release & Waiver," "Consent to Photographs and Video," and "Waiver and Release Regarding Photographs and Video" sections.
• Place a checkmark in the box indicating you have read the information.
• Fill in your full name, address, and daytime phone number.
• Sign your name in the "signature" section.
• If you are a minor (under the age of 18), fill in your parent/guardian’s name.
• If you are a minor, have your parent or guardian sign their name and fill in the date.

Bring the completed form to the registration table at HMSA’s go Walk@Lunch event on April 29, fax it to 948-6860, or mail it to the address below prior to the event.

HMSA
Marketing & Communications Department
go Walk@Lunch
P.O. Box 860
Honolulu, HI 96808-0860