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* 1. First Name

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* 2. Last Name

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* 3. Gender

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* 4. Please indicate faculty or staff.

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* 5. Please enter your 9-digit Bruin ID # (found on your BruinCard):

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* 6. Department

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* 7. Email (Prize winners will be notified via email)

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* 8. Donate slightly used workout clothing and/or shoes to UCLA's FITTED student group and you'll be entered into a drawing for a pair of adidas running shoes.

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* 9. I will attend the following walks (select all that apply):

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* 10. Due to high demand, we are no longer accepting reservations for Know Your Numbers on February 19.

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* 11. If you are selected for a prize, which items would you like to receive most? (select all that apply)

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* 12. To assist with ordering sizes, what t-shirt size do you normally take? Note - shirts are gender neutral and sizes cannot be guaranteed.

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* 13. How did you find out about the 2015 I Heart Walking Week?

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* 14. Are you currently a member of UCLA Recreation? If not check out our great packages at www.recreation.ucla.edu/newmembers

In order to complete your registration, Please read the following waiver HERE and indicate below you have read and understood this document.

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* 15. I understand by agreeing, my signature is being transferred electronically, and I will not challenge the validity of the signature in any legal proceeding in which this document may be offered or used.

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