Driving Out Cancer Registration

Registration Form

Please fill out the following form to register for the Cancer Services of New Mexico Driving Out Cancer event.

Name

Street Address

City

State

Zip Code

Phone Number

Car Information

Make

Model

Year

Color

Tell us a litte bit about your car!

I understand the registration fee is $25 and is required for including your vehicle. The $25 can be paid via this paypal link after completing this registration form. Your registration is not complete until the payment is submitted.

Waiver/release statement: I agree that neither Cancer Services of New Mexico (CSNM), US Eagle Federal Credit Union, nor their employees, agents, or volunteers associated with Driving Out Cancer shall be held responsible for any injuries, damages, or loss of personal property that occur to myself or others who participate with me while attending, participating, or witnessing in any Driving Out Cancer activity. I hereby assume full risk, waive all claims and release and hold CSNM and US Eagle Federal Credit Union, and their employees, agents or volunteers associated with Driving Out Cancer, individually or otherwise, harmless for any and all claims for injuries or damages.

Photo/Video Release statement: I further grant permission for myself and others who participate with me to appear in person or in voice, video or photographic presentation for radio, television, or print media reports and/or media campaign(s) resulting from participation in Driving Out Cancer.

Driving Out Cancer Registration

Registration Form

Car Information

Driving Out Cancer Sponsors