PurpleStride Kashiwa/Tokyo 2018
Individual/Family Registration Form

DATE:NOVEMBER 18, 2018 (SUNDAY)
PLACE:HIBIYA PARK, Fountain Plaza


■FAMILY/INDIVIDUAL REGISTRATION FORM

Please kindly enter one individual at a time.

Child under the age of 12 needs to have a parent accomany her/him.

●TEAM/GROUP REGISTRATION
Team/Group registration is handled differently.

In order to register a Team/Group, please send a leader's name, email address, and team members' name, course, and T-shirt size to info@pancan.jp.

Please note that the registration fee must be deposited on time to qualify for the early registration fee.
NAMErequired
FAMILY NAME 
FIRST NAME 
YOUR CATEGORYrequired

*PATIENT: DIAGNOSED AS PANCREATIC OR NET CANCER PATIENT, WHO RECEIVED TREATMENTS IN THE PAST NEED TO SPECIFY AS PATIENT IN ORDER TO BE INVITED AS PANCAN GUEST.

THERE WILL BE A CEREMONY TO HONOR AND RECOGNIZE PATIENTS DURING OPENING CEREMONY, SO PLEASE KINDLY COME TO THE SURVIVOR TENT TO BE RECOGNIZED.
EARLY REGISTRATION FEErequired

Adult and Child fee are different
COURSErequired
Your 5K Time Goal
10K RUN ONLY
Top 3 runners are each given a medal during award ceremony

T-SHIRT SIZErequired

WE MAY NOT HAVE ENOUGH SIZES AVAILABLE ON THE DAY OF EVENT.

PLEASE KINDLY MAKE A SELECTION AT THIS TIME.

WE RECOMMEND ONE SIZE LARGER IF IT IS TO BE WORN ON TOP OF OTHER CLOTHES〕
EMAIL required

確認用
WE RECOMMEND SPECIFYING YOUR EMAIL ADDRESS THAT YOU CAN RECEIVE ON YOUR PC OR IPAD. WE EXPERIENCED IN THE PAST THAT OUR CONFIRMATION MAIL SENT TO A CELL PHONE ADDRESS IS OFTEN REJECTED AND DOES NOT REACH THE PERSON REGISTERED.
ADDRESS
都道府県
市区町村
町名番地等
建物名

PLEASE SPECIFY IN THIS ORDER (PREFECTURE,CITY,TOWN,BUILDING)
STREET ADDRESS (IN ENGLISH)
PHONE NUMBER (IN CASE OF EMERGENCY)required
 -  - 
USE SINGLE BYTE CHARACTER

HOW DID YOU FIND OUT ABOUT THIS EVENTrequired
PanCAN Newsletter/Events
Donation

PurpleSTRIDE is a charity event to raise money for increasing disease awareness of this dreadful disease, open US research community to Japanese researchers, engage medical professionals to make available the latest drugs here in Japan. We raise money to stomping pancreatic cancer. Please join the fight.

In Honor of
In Memory of
Registration is completed when the fee is deposited into PanCAN account.

①Early registration fee is 3000 yen until October 30th. After that it is 3500 yen per person.

For Elementary school child, the early registration fee is 1000 yen


②Registration fee should be paid within one week of entry.

③Registration is closed on November 1st. Fee must be received by October 30th and confirmed on November 1st.

After that date, it has to be handled at the Onsite Registration desk on the day of the event.

Adult Entry Fee = 3500 yen
Elementary School Child Fee = 1200 yen


Terms and Condition of the Event must be read before submitting this form. When the form submitted, it is agreed that the Terms and Conditions of the Event are read and accepted by the applicant.

■ Terms and Conditions of the PurpleSTRIDE 2018 Event

* We have indicated the Terms and Conditions concerning this event below.

Since we accept your application submission as your acknowledgement and acceptance of these Terms and Conditions, please be sure to read the Terms and Conditions in advance, Thank you.


TERMS AND CONDITIONS

● Participants are required to take a medical examination in advance and participate under their own responsibility, with good health and management.

● In the event of an accident, please be aware that the organizers are only responsible for the insurance category that are covered.

● Regarding insurance, we will have the event insurance for all participants. For insurance enrollment purpose, please write accurately about your contact information. Make sure there is no omission in the address, contact information, etc.

● For elementary school students, we will require a parental consent.Please be sure to indicate that the parent's consent is obtained for the child applicant.

● Please inform the Secretariat promptly when you want to cancel. Also, please understand that we may discontinue the event due to force majeure, natural disasters, earthquakes, not related to organizers' responsibilities.

●Organizers have the right to take videos, photos, pictures, articles, voice recordings, etc. during the event. Organizers have the right to use them for TV, newspapers, magazines, internet publications, etc, for promotion of the event. Moreover, please understand that the copyright of the event recordings belongs to the organizers.

● Personal information of the applicant is managed by the organizing committee. It is used for the purpose of the event management and also for the future related events, but will not be used for other purposes.