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Walk from Obesity Event Application
Located below, you will find the Walk from Obesity event application. Please complete the application and click "Submit" once you are finished. Note: All alternate dates must be approved by the National Office. Please call (866) 471-2727 for more information. If you have any questions, please contact us at info@walkfromobesity.com

Fall Event applications must be received by June 1st, 2012
Committee Chair Information:
Please provide contact information for the Walk committee chair.
Presenting Sponsor/Facilitating Member Information
Provide contact information for the presenting sponsor/facilitating member.
*Note: The presenting sponsor/facilitating member must be an ASMBS or OAC member.
Other Presenting Members
Enter the name(s) of physician(s), hospital(s) or other organization(s) who will be helping to present your event.
I have read and understand the Walk from Obesity agreement (SEE BELOW), and do hereby full agree to follow all established guidelines, policies, procedures and standards as set by the ASMBS Foundation’s and/or OAC’s Board of Directors and Staff.
I understand the Walk from Obesity is a fundraising event and understand a minimum fundraising goal of $10,000 will be set for my event.
* Required

 Walk from Obesity 2012 Event Agreement

  1. By checking the above box, I agree to co-facilitate with others in my area that wish to participate (within a 30 mile radius) in the Walk from Obesity 2011/2012 event.
  2. I understand that I (or other co-leaders) may not use the Walk from Obesity event to promote any individual practice, service or hospital program.
  3. I agree that the purpose of the event is to raise community awareness of the disease of obesity, and to raise funds for prevention, education, research and treatment of obesity; and as such, I agree to incorporate all of those who have an interest in helping people fight the disease of obesity.
  4. I understand and agree that as a participant in this non-profit event, I may not, nor may any individual person, vendor, sponsor, hospital program medical practice, or other entity sell any product, goods, or services at the Walk from Obesity Event. I understand and agree to enforce this no-sales policy as to not endanger the 501(c)(3) status of the ASMBS Foundation and/or the Obesity Action Coalition.
  5. I agree to completely follow all guidelines, policies, procedures and standards set forth in the official Event Committee Guide and all other instructions provided by the ASMBS Foundation and/or Obesity Action Coalition Board of Directors and Staff.
  6. I agree to put any request(s) for guideline changes and/or special permission(s) in writing directly to the ASMBS Foundation office for review and consideration.
  7. I agree to work with all National Event Sponsors as outlined in the National Event Committee Guide.
  8. If my application is approved, I agree to pay a non-refundable site registration fee of $500 by the registration fee deadline (an invoice will be provided). I understand that if my walk has a co-facilitator (or multiple co-facilitators), the fee may be divided among the group.