Individual Registration

Choose from one of the following options to continue registering:

I AM A NEW
PARTICIPANT

Individual First Name:*

Individual Last Name:*

Individual Email:*

Confirm Email:*

By registering as a participant and providing your email address, you are agreeing to receive important participant event updates via email.

User Name:*

A user name and password must be entered in order to be able to access and update your personal fundraising page.
Enter a unique user name for each individual of the event. No spaces allowed.
(i.e. first and last name: janedoe or first initial and last name jdoe)

Password:*

Minimum 6 characters. At least one letter and one number.
Only enter letters, numbers, periods, hyphens or exclamation marks.

Confirm Password:*

I would like to set a goal of:*

CLICK BELOW TO SELECT A FUNDRAISING GOAL. You can participate and also setup a personal fundraising page to help raise extra funds to raise awareness of suicide prevention in our community.
This goal is not a commitment, but rather what Long Island Crisis Center hopes you will be able to raise for our cause.

In addition to registering, I would like to make a donation in the amount of:

$.00

Preferred Shirt Size (while supplies last):*

Small
Medium
Large
X Large
2X Large

Waiver and Release
In consideration of this entry being accepted, I hereby for myself, heirs, executors, and administrators, waive and release any claim I may have against Long Island Crisis Center, its officers and directors, the organizing committee, the sponsoring organizations, the City of Long Beach or their representatives, successors, or assignees for any injury that may be suffered by me at or in this event.

Release:*

I have carefully read this Waiver and fully understand its contents. I am aware that by accepting this Waiver, I am waiving legal rights and knowing this, I accept it of my own free will.

Preferred Shirt Size (while supplies last):*

Small
Medium
Large
X Large
2X Large

Waiver and Release
In consideration of this entry being accepted, I hereby for myself, heirs, executors, and administrators, waive and release any claim I may have against Long Island Crisis Center, its officers and directors, the organizing committee, the sponsoring organizations, the City of Long Beach or their representatives, successors, or assignees for any injury that may be suffered by me at or in this event.

Release:*

I have carefully read this Waiver and fully understand its contents. I am aware that by accepting this Waiver, I am waiving legal rights and knowing this, I accept it of my own free will.