I will be participating by:
Running
Walking
________ Sleeping In
Supporting MMM through my
personal donation.
Waiver: In consideration of the acceptance of my
entry, I hereby waive on behalf of myself, my heirs,
executors, and assigns, any and all claims of any
nature arising from or due to my participation in the
MMM Mary Miller Memorial 5K Walk/Run. I also
hereby release Milford Miami Ministry, all sponsors,
workers, officials, and volunteers from any and all
claims arising from or due to my participation in this
event. I agree to follow all the rules of participation
and acknowledge that the race committee may refuse
or return my entry at its discretion. I understand the
risks for such a run or walk, and have trained and
prepared adequately in preparation for this event. I
HAVE NOTED ANY MEDICAL CONDITION ON THE
BOTTOM OF THIS FORM. I permit the use of my
name and picture participation in this event for
publicity, for no additional consideration. I also
understand that entry fees are non-refundable.
ADDITIONAL DONATIONS
For those who support MMM but do not
wish to run or walk, consider collecting
pledges from your friends and family. Use
the form below to record your collections
and join us on race day to turn in your
pledges and join in the fun.
Sponsor Name
Amount Donated
$
$
$
$
$
$
Signature:
$
Date:
$
Parent Signature (if under 18):
$
$
Mail entry form with fee and/or donations to:
Milford Miami Ministry
c/o Jan Gerdom
11637 Chancery Lane
Cincinnati, OH 45249
4th Annual
MMM
Mary Miller
Memorial
5K Walk/Run
I am not able to participate on race day but
would like to make a donation to MMM:
Donation Amount:
$
THANK YOU FOR YOUR SUPPORT!
Saturday, April 11, 2015
Miami Meadows Park
1546 State Route 131
Milford, OH
MMM
Mary Miller Memorial 5K Walk/
Run
Your participation in this event helps Milford
Miami Ministry (MMM) provide food and
emergency financial assistance to families in
need. Since 1996 MMM has provided help to
families in Milford and Miami Township who
reside within the Milford EVS District. Your
registration will help continue this important
ministry.
We also honor the memory of Mary Miller who
assisted so many families in the Milford area
during her lifetime. The Mary Miller Fund was
established in 1952 and many Milford students
fondly recall donating pennies, nickels and
dimes to support her work. Since Mary’s death
in June, 2009 MMM is honored to continue her
legacy by distributing funds collected through
the Mary Miller Fund to those in need.
All proceeds will benefit
EVENT DETAILS
ENTRY FORM
Course. The 5K route will wind through
beautiful Miami Meadows Park.
Registration. Pre-registration is available by
mailing your entry form and fee to Milford Miami
Ministry, c/o Jan Gerdom, 11637 Chancery Lane,
Cincinnati, OH 45249. Online registration is
also available at GetMeRegistered.com/
MMM5K.
Pre-registration fees are $25 for adults (ages
15+) and $10 for youth (ages 7-14). Teams of
six or more can register together at a reduced
price of $20. Youth included in team
registrations will be at stated fees. Preregistration for adults and youth received by
April 1 will include a t-shirt and while supplies
last for those received April 1 and after. We
hope children 6 and under will enjoy the event
with their families at no cost.
If you would prefer to “Sleep In” on race day,
you can make a difference without leaving
home. Your registration fee will support MMM
and your t-shirt will be available for pick up,
mailed or delivered to you.
Race day registrations will be $30 for adults
(ages 15+) and $15 for youth (ages 7-14) and
will include a t-shirt while supplies last. Teams of
six or more can register at a reduced price of
$25.
(Waiver on back must be signed)
First Name:
Last Name:
Address:
City:
State:
Zip:
E-mail:
Birthdate:
Gender:
M
Emergency Contact Name:
Emergency Contact Phone:
MMM Church Affiliation (if applicable):
Circle T-shirt Size: (circle size)
Youth S M L Adult
MMM MISSION STATEMENT
Through the affirmation of our faith in Jesus Christ, we will
act in love as the hands and feet of our Lord and Savior,
seeking to provide service and support to members of our
community in their time of need.
Awards. The top 3 male and female adult and
youth runners will receive prizes. Door Prize
awards will be drawn from all participants.
Complete race results will be available at
MMMinistry.org.
Questions. For more information e-mail
[email protected]
S M L XL XXL
Fee Enclosed:
$25 for ages 15+
Check-in and registration from 7:30 am to 8:30
am with the race start at 9:00 am rain or shine.
Kids Fun Run. A free Fun Run for children 6
and under will be held at 10:15 a.m. Prizes will
be given to all participants.
F
_________
$20 Group of 6+
registering together
$10 for ages 7-14
Waiver must be signed on the reverse
side of this form to complete registration.
Mail registration fee and completed entry
form to the address on the reverse side of
this form.
Please make all checks payable to
Milford Miami Ministry