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
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.
Marketing & Communications Department
P.O. Box 860
Honolulu, HI 96808-0860