Greater Los Angeles Chapter
PO Box 565
Agoura Hills, CA  91376-0565

WAIVER

I, _______________________________ (printed name) hereby waive all claims against The ALS Association, Greater Los Angeles Chapter, sponsors or personnel for any injury that I may suffer from my participation in this event.  I grant full permission for organizers to use photographs, videotapes, motion pictures, recording or any other record of this event in which I may appear for any legitimate reason.