how to get involved
and make a difference
in your community
it’s
easy as
1,2,3!
1
making a difference
The purpose of CARSTAR’s Great Strides™ Walk
for Cystic Fibrosis Canada is to raise funds to help
Canadians living with cystic fibrosis who urgently
need a cure or control for cystic fibrosis.
You can use the pledge form in this brochure to
ask your network for donations. Be sure to bring
it and all funds raised to the walk on Sunday,
May 31, 2015 in order for your donors to receive
tax receipts. You can visit us online at www.
cysticfibrosis.ca/greatstrides to register and enter
your donations online for your supporters to
receive electronic tax receipts.
2
register
There are four ways to register for CARSTAR’s
Great Strides™ Walk for Cystic Fibrosis Canada:
ONLINE: www.cysticfibrosis.ca/greatstrides
EMAIL: [email protected]
CALL: 1-800-378-2233
IN PERSON: Visit us on walk day, Sunday, May 31,
2015 at one of our walk locations (contact us or
visit www.cysticfibrosis.ca/greatstrides to find a
walk location near you)
3
teamwork and awareness
Gather friends, family, teammates, club members,
and/or colleagues to form a CARSTAR’s Great
Strides™ Walk for Cystic Fibrosis Canada team.
Motivate and encourage others to participate and
support a cause that funds vital cystic fibrosis
research, care and advocacy initiatives.
To start building your team and raise awareness
visit www.cysticfibrosis.ca/greatstrides today!
The generosity of CARSTAR’s Great Strides™ Walk
for Cystic Fibrosis Canada donors and supporters
enables Cystic Fibrosis Canada to improve the
lives of Canadians with cystic fibrosis.
why your support matters
Cystic fibrosis affects the lungs and digestive system and is
the most common fatal, genetic disease affecting Canadian
children and young adults.
The mission of Cystic Fibrosis Canada is to help people with
cystic fibrosis. We fund research towards the goal of a cure or
control for cystic fibrosis, support high quality CF care, promote
public awareness of cystic fibrosis, and raise and allocate funds
for these purposes.
For more information about Cystic Fibrosis Canada or to donate,
visit www.cysticfibrosis.ca/greatstrides today.
Cystic Fibrosis Canada’s Infection Prevention and Control
Policy: The health and well-being of people with cystic
fibrosis is our top priority. Attendance by people with cystic
fibrosis to Cystic Fibrosis Canada’s hosted or sponsored
outdoor events are at the individuals’ own risk.
For more information on Cystic Fibrosis Canada’s
Infection Prevention and Control Policy, please visit www.
cysticfibrosis.ca/about-us/infection-prevention-andcontrol
thank you to our sponsors
Cystic Fibrosis Canada would like to extend a tremendous
thank you to our sponsors. Their passion, dedication and hard
work are helping create a world where cystic fibrosis is no
longer a progressive life-shortening disease.
Official Title Sponsor
National Walk Partners
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CysticFibrosisCanada
@CFCanadaWalk | @CFCanada
REGISTRATION INFORMATION
1) q Please check this box if you have also registered online. If so, please write your name as you have recorded it
online so that we can match your profile.
2) Please bring this form and all funds collected to your CARSTAR’s Great Strides™ Walk for Cystic Fibrosis Canada
walk location. Cheques can be made payable to Cystic Fibrosis Canada.
If you are not able to attend the walk in person, please mail this form and include all your funds to CARSTAR’s Great
Strides™ Walk for Cystic Fibrosis Canada c/o Cystic Fibrosis Canada, 2323 Yonge Street, Suite 800, Toronto, ON,
M4P 2C9 by June 12, 2015.
First Name:
Last Name:
Address:
Suite or Apt#:
City:
Province:
Postal Code:
Telephone (home):
(business):
ext.:
E-mail:
Language preference: q English
q French
Company Name:
WAIVER, INDEMNITY & PHOTO RELEASE:
Please read carefully
I agree: 1) That at all times during CARSTAR’s Great Strides™ Walk for
Cystic Fibrosis Canada, my safety remains my sole responsibility and
2) that I will discontinue from participating in this event if requested
to do so by any representatives of Cystic Fibrosis Canada and 3) that
I am aware of the inherent risks in participating in this event and
voluntarily assume such risks. IN CONSIDERATION of acceptance as a
participant in this event, I myself, my heirs, administrators and assigns
HEREBY RELEASE, WAIVE and FOREVER DISCHARGE Cystic Fibrosis
Canada and all its associations and sponsoring companies and all its
respective agents, officials, officers, directors, employees, servants,
conductors, representatives, successors and assigns OF AND FROM
ALL claims, demands, payments, actions, causes of action, damages,
costs and expenses, in respect of death, injury, loss or damage to my
person or property HOWEVER CAUSED arising or to arise by reason
of my participation in the said event AND NOTWITHSTANDING that
same may have been contributed by the negligence of any of the
aforesaid. I FURTHER UNDERTAKE TO HOLD AND SAVE HARMLESS
and AGREE TO INDEMNIFY all the aforesaid from and against any and
all liability incurred by and or all of them arising as a result or in any
way connected to my participation in said event. BY SUBMITTING
THIS ENTRY I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND
AGREED to the above AGREEMENT, RELEASE, WAIVER AND INDEMNITY, I
WARRANT that I am physically able to participate in this event.
The undersigned also grants to Cystic Fibrosis Canada, in whole or
in part, the right to use the film footage/photographs of myself or of
my children, produced for promotional purposes, provided that said
footage/prints, in whole or in part, including voice-overs, be used
exclusively by the above mentioned organization.
Participant’s Name (print):
PLEDGE INFORMATION
Tax receipts will be issued for all donation amounts of $20 or over. All donor information below MUST be completed in order to receive
a tax receipt. For electronic tax receipt requests an email address must be provided in addition to the above.
1 Donor’s Name (First/Last)
Credit
Phone
Amount
Cash
Cheque
q print
Street Address or PO Box (suite/apt./unit)
City
E-mail
Province
Postal Code
2 Donor’s Name (First/Last)
q electronic
Credit Card #
Expiry (MM/YY)
Phone
q print
Street Address or PO Box (suite/apt./unit)
City
E-mail
Province
Postal Code
3 Donor’s Name (First/Last)
q electronic
Credit Card #
Expiry (MM/YY)
Phone
q print
Street Address or PO Box (suite/apt./unit)
City
E-mail
Province
Postal Code
4 Donor’s Name (First/Last)
q electronic
Credit Card #
Expiry (MM/YY)
Phone
q print
Street Address or PO Box (suite/apt./unit)
City
E-mail
Province
Postal Code
5 Donor’s Name (First/Last)
q electronic
Credit Card #
Expiry (MM/YY)
Phone
q print
__________________________________________________________
Team Captain Name:
Team Name:
(please write your team name exactly as it is registered online):
Team Type:
q Family and Friends Team
q Corporate Team
q Association or Membership Team
* I n the event a parent or guardian is accompanying more than one
minor from the same household, the parent or guardian is permitted
to sign one waiver, as long as all participating minors are listed
above. I approve and give my consent to the participation of the said
minor(s) in this event and also adopt the above release for myself.
q School Team
Are You A Member/Employee/Family of One of the Following?
q CARSTAR Canada
q Kin Canada:
q Siemens Canada
Date:______________________________________________________
q EllisDon
District #___________________
ClubName:________________________________________________TeamName:____________________________________________
q Other (Please Write Full Name):
Signature (Parent/Guardian):_________________________________
___________________________________________________________________________
Street Address or PO Box (suite/apt./unit)
City
E-mail
Province
Postal Code
6 Donor’s Name (First/Last)
q electronic
Credit Card #
Expiry (MM/YY)
Phone
q print
Street Address or PO Box (suite/apt./unit)
City
E-mail
Province
Postal Code
q electronic
Credit Card #
Expiry (MM/YY)
Instead of bringing cash with me to walk day, I would like to pay the following on my credit card: Amount $_____________
(you can also visit us www.cysticfibrosis.ca/greatstrides for payments) q VISA q MasterCard
q AMEX
Name on Card: __________________________________ Credit card#: ______________________________________ Expiry Date: _______
Signature: _______________________________________
Are you q Male
Cash/Cheque/Credit Total:
Include Online Total here:
GRAND Total:
Pg ___ of ____
q Female
Please select your age range q 3 years and under q 4 - 16
Tax Receipt
Request
q 17 - 25
q 26 - 35
q 36 - 45
q 46 - 54
q 55 and over
By completing this form and submitting to Cystic Fibrosis Canada, you hereby consent to the collection and use, by the
organization of your personal information in accordance with Cystic Fibrosis Canada’s Privacy Policy. Our policy details are
available by sending an e-mail to [email protected] with “Attention Privacy Officer” in the subject line, or by contacting
Cystic Fibrosis Canada at (800) 378-2233. Charitable Registration: # 10684 5100 RR0001