Sunday, May 3, 2015- 2 pm Riverside Park, Findlay, OH 5K Run, 1-Mile Fun Run & 1-Mile Walk or Stroll *All Proceeds Benefit rettsyndrome.org -----------------------------------------------------------------------------------------------------------------------------------------------------------------complete the Registration Form for each participant: Participant Information (Please Print Clearly) Name: _______________________________________ Age on Day of Event: ______ Gender: M / F Address: _______________________________________________________ City: _________________ State: _____________________ Zip Code:____________ Phone: _______________ Email: ____________________________________________ Event Participation: 5K Run ____ 1-Mile Fun Run ____ 1-Mile Walk/Stroll ____ Event Fees: Adults - $20.00 _____ Youth (HS and younger) - $15.00 _____ Volunteer only_______ Shirt Size: Men: S / M / L / XL / 2X / 3X Ladies: (100% Cotton) : S / M/ L/ XL /2X / 3X Children: S / M / L/XL *Shirts included, if registered by April 15, 2015! Shirts are $10 on race day while supplies last. WAIVER: I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors and administrators waive and release any and all claims for damages I may have against Rett Syndrome.org, the City of Findlay, Hancock County Park District, all sponsors and their representatives, chairpersons for the Live Rett Free event, and assigns for any injuries suffered by me in said event. I verify that I am physically fit and have sufficiently trained for the completion of the event and my physical condition has been verified by a licensed doctor. _____YES I have read and agree to the above waiver _________________________________________________ Signature of Participant _____________ Date (or signature of a Parent or Guardian if entrant is age 17 or under) Check Enclosed –make payable to: Rett Syndrome.org Mail Registration and Payment to: IRSF / Karen Herold P. O. Box 163 Findlay, OH 45839 – 0163 Online Registration is at: www.firstgiving.com/rettsyndrome/liverettfree **Additional Information on the back of this registration Please Event Location: Event Highlights: When: 231 McManness Ave., Findlay, OH – Riverside Park The 5K Run / 1-Fun Run / 1-Mile Walk & Stroll will be along the Findlay Heritage Trail and around Riverside Park. The event will support research and funding to find a cure for Rett Syndrome. May 3, 2015, Event Day Registration & Packet pickup will be @ the Riverside Pavilion: 5K Run Packet Pickup from – 1pm tp 1:45 1M Fun Run / Walk Packet Pickup – 1pm tp 2:30 1M Fun Run / Walk starts 3pm To be pre-registered your completed registration form must be received before April 15 Entry Fees: $20.00 for Adults & $15.00 for Youth (HS and below). Participants that register after April 15, can purchase a cool race / event T-shirt for $10.00 Awards (5K Run): Awards will be provided for the top individuals in each age group as well as the overall male and female runners. Contact Information: Please feel free to contact us at [email protected] or Amanda at 419-306-4234 or Karen at 419-957-3875 Event Organizers: Karen & Greg Herold and Amanda & Dan Jacobs ------------------------------------------------------------------------------------------------------------------------------------------ If you would like to become a sponsor for the Live Rett Free event or make a donation to the International Rett Syndrome.org, please see the information below: $2500 - Presenting Sponsor – Designation as the Presenting Sponsor at the Live Rett Free Event. The Presenting Sponsors name and logo will be printed on all materials, on all press releases, advertising, and may have an info table and banner at the event. $1000 - Gold Sponsor – Designated as the Gold Sponsor at the Live Rett Free Event. The Gold Sponsors name and logo will be printed on all printed materials and advertising for the Live Rett Free event. $500 - Silver Sponsor – Designated as the Silver Sponsor at the Live Rett Free Event. The Silver Sponsors name and logo will be printed on all printed materials and advertising for the Live Rett Free event. $250 - Bronze Sponsor – The Bronze Sponsors name and logo will be printed on all printed materials. $150 - Star Sponsor – The Star Sponsors name or logo will be printed on the T-shirts. Donations – We love and accept them all for Live Rett Free and IRSF! Sponsor/Donation Information (Please Print Clearly) Name / Company Name: ____________________________________ Email:___________________ Address: _______________________________________________________ City: _________________ State: _____________________ Zip Code:____________ Phone: _______________ Please mail your Support or Donations payment to the following address: IRSF / Karen Herold P. O. Box 163 Findlay, OH 45839 – 0163 Or Donate online at: www.firstgiving.com/rettsyndrome/liverettfree
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