1. business and industrial

Mudders for Moms
Looking for an opportunity to get down
and dirty? On Sunday,
Sunday, April 19,
19, 2015 the
Phoenixville Area High School Youth
and Philanthropy
Philanthropy class (PHYGHT)
(PHYGHT) is
hosting a mud run to support Mom’s
House.
House.
(Please visit: www.momshouse-phoenixville.org)
Start Time: 10 a.m. (registration opens at 9)
Cost:
$35 adult, $25 (student with id)
$75–family rate (4 entries)
$100 – group rate (5 entries)
1 Mile Inner Loop Walk
$20 – Shirt Included
$10 – Shirt Not Included
Fun Facts: Food trucks available and awards for the participants!
•T-shirts for all pre-registered (by 4/3/15) and while they last on race day
•Water and snacks provided
Location: Phoenixville Area High School Campus and
campus of the proposed Early Learning Center
(formerly Meadowbrook Golf Course)
1200 Gay St, Phoenixville PA 19460
REGISTRATION FORM
Please contact Scott Smiley ([email protected]) with any questions regarding the event
Online registration available at www.momshouse-phoenixville.org
CONTACT INFORMATION
Name
Address
City
State
Phone
Email
Zip Code
INDIVIDUAL PARTICIPANT INFORMATION
FIRST AND LAST NAME
Gender
EVENT
FEE
Mud Run
$35.00
AGE
T-SHIRT SIZE
M F
S
M
L
XL
M F
S
M
L
XL
M F
S
M
L
XL
M F
S
M
L
XL
M F
S
M
L
XL
QTY
SUBTOTAL
Adult
Mud Run
$25.00
PAHS Student, must register with Mr. Smiley in H9
Family Rate
Group Rate
Inner Loop
Walk
$75.00
4 registrations
$100.00
5 registrations
$20.00 (includes shirt)
$10.00 (no shirt)
I am unable to attend but would like to donate: $_________________
TOTAL
Make checks payable to “Mom’s House”
Mail to Mom’s House: 145 South Main St. Phoenixville, PA 19460 or bring with you to the event.
WAIVER AND RELEASE OF LIABILITY
In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, waive and
release all rights and claims for damages I may have against the organizers, sponsors, volunteers, officials and any other
individuals associated with this event and will hold them harmless from any injury suffered by me. Also, none of the
above are responsible for the loss of personal items nor any other form of aggravation in connection with said event. I
understand that off-road racing and “mud runs” are a potentially hazardous activity.
Signature (Guardian if Under 18)
Date
“Mudders for Moms “ Sponsorship Sign-Up
Thank you for choosing to sponsor the “Mudders for Moms” Mud
Run. This run benefits Mom’s House of Greater Philadelphia located
in Phoenixville, PA. Your sponsorship will make it possible for a lowincome, single parent to create a better life for their family by
furthering their education.
Please complete the following information so that we can accurately
list your company in promotional materials for the run.
Company Name:_________________________________________
Contact Name__________________________________________
Address:______________________________________________
Phone:_______________E-mail____________________________
Sponsorship Level (see attached list)________________________
Please supply us with camera ready art for your company name or
logo by March 16, 2015.
Check Enclosed payable to “Mom’s House” or charge my credit card
Type_____ Number_____________________________________
Expiration _________Signature____________________________
Gift in Kind (food/drink, raffle prize etc)____________________
Any questions, please contact Wendy McKeon, Finance Director at
610-935-7711 or [email protected]
SPONSORSHIP LEVELS “MUDDERS FOR MOMS”
SPONSOR A MUDPIT ($500)
Company recognized at awards ceremony
Company recognized on Moms House website and Facebook
Company banner/sign displayed at mudpit
Company receives top listing on sponsor acknowledgment board
Large company name on T-Shirt and 4 free participants
Company name included on sponsor page of race brochure
DOCTORATE LEVEL ($400)
Company recognized at awards ceremony
Company recognized on Mom’s House web site and Facebook
Company receives listing on sponsor acknowledgment board
Large company name on T-Shirts and 4 free participants
Company name included on sponsor page of race brochure
MASTER’S LEVEL ($200 +)
Company name on Sponsor acknowledgement board
Company name on T-Shirt and 2 free participants
Company name included on sponsor page of race brochure
BACHELOR’S LEVEL ($100)
Company name on Sponsor acknowledgement board
Company name included on Sponsor page of race brochure