Registration Form for 2027 Dunk Alzheimer's

Contact Info

First Name

Last Name

Street Address

Unit or Apartment Number

City

State or Province

Postal Code

Country

Phone Number

Email Address

Yes, I would like to receive UsAgainstAlzheimer's email communications.

Event Ticket Information

Exclusive Water Bottle Sponsor (Includes 12 players)

Sub Total

$0.00

Photobooth Sponsor (Includes 9 Players)

Sub Total

$0.00

Gold Sponsor (Includes 9 Players)

Sub Total

$0.00

Silver Sponsor (Includes 6 Players)

Sub Total

$0.00

Bronze Sponsor (Includes 3 players)

Sub Total

$0.00

Community Supporter (Support 3 lower income players in the tournament)

Sub Total

$0.00

Early Bird 3-Player Team

Sub Total

$0.00

Early Bird Single Player

Sub Total

$0.00

T-Shirt Only

Sub Total

$0.00

Dunk Alzheimer's Supporter (No Players, Just Donation)

Sub Total

$0.00

Additional Donation

Amount

Payment

Card Number

Expiration Date

Name On Card

CVV Code

Account Number

Routing Number

Name On Account

Account Type

Checking

Savings

Billing Street Address

Billing Unit or Apartment Number

Billing City

Billing State or Province

Billing Postal Code

Billing Country

Player Information (Not playing, please put N/A)

Team Name (If single player, enter single player here)

Player Name(s), Age(s), T-Shirt Size(s)

Project and Approach

By registering for the Dunk Alzheimer's event, I understand and agree that UsAgainstAlzheimer's and KidzEndAlz are not responsible for any injury or property damage I may sustain by my participation in the event, even if caused by their ordinary negligence wherever, whenever, or however the same may occur. I understand that participation in the event involves certain risks, including but not limited to the risk of significant personal injury. I am voluntarily participating in the event with knowledge of the risks involved and agree to accept all risks of participation. I consent to administration of first aid and other medical treatment in the event of injury or illness. I also agree to indemnify and hold harmless UsAgainstAlzheimer's and KidzEndAlz for all claims arising out of my participation in the Event, related activities including, but not limited to, transportation to and from the Event, and the administration of any first aid and/or medical treatment. This event will be photographed and/or videotaped, and so by registering and attending the event I consent to allow KidzEndAlz and UsAgainstAlzheimer's to use my name, image and likeness for advertising, fundraising and promotional purposes (the “media”). I understand that I will not own any rights in the media and shall not have the right to enjoin the development, production, distribution, or exploitation of the media by KidzEndAlz and UsAgainstAlzheimer's.

UsAgainstAlzheimer's is engaged in a relentless pursuit to end Alzheimer's, the sixth leading killer in America. Our work centers on prevention, early detection and diagnosis, and access to treatments – all regardless of gender, race, or ethnicity. To achieve our mission, we give voice to patients and caregivers while partnering with government, scientists, the private sector, and allied organizations -- the people who put the “Us” in UsAgainstAlzheimer's.