Registration Form Cooper River For More Information: Call the Jingle Bell Run/Walk HOTLINE...
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Registration Form Cooper River For More Information: Call the Jingle Bell Run/Walk HOTLINE 1-888-467-3112 (in NJ) 1-732-283-4300 x 313 [email protected] Sponsorship & Team Opportunities Available! Register Online www.2007jbrwcooperriverpark.kintera.org Do you have arthritis or a related disease? ___Y ___N Name: ______________________________ If Yes, what type? ___________________ Address: ____________________________ I heard about this event from: _____________________ City: ________________________________ State: ________________ Zip: ___________________ Age: _______ Gender: _________ Phone Day: ____________________Eve: ___________________ Email: _______________________________________________________ I am planning to raise pledges. My pledge goal is $ __________ I have added a donation below to support the Arthritis Foundation Registration Fee (includes t-shirt, bells & “Beat the Cold” Goodie Bags) $20 prior to 10/15/07 $22 through 11/14/07 $25 beginning 11/15/07 through day of event Payment by: ___Cash ___Check ___MC ____Visa ____Amex Acct # __________________________________ Exp: __________ Signature: ______________________________________ * Make checks payable to the Arthritis Foundation : ___5K Run ___5K Walk ___Volunteer : ___S ___M ___L ___XL ___XXL te ___Individually ___With a team* (minimum of 10 people) se send in all individual team member’s registration forms together with payments and team roster. nderstand that the Arthritis Foundation New Jersey Chapter, the Jingle Bell Run/Walk for Arthritis sponsors, the area where I, or my child, run or wal h this event are not to be held responsible for any injuries which I, or my child, may suffer while taking part in this event, or as a result thereof. es to my person, child or property. I further state that my child or I are in proper physical condition to participate in this event. I grant permis er record of this event for any legitimate purpose. ature _____________________________________________________________________________ Date __________________ under 18, parent or guardian’s signature ___________________________________________________ Date _____________ Team Name: ____________________________ Team Captains: __________________________ Event Sponsors: Date: December 8, 2007 Location: Cooper River Park, Boat House Pennsauken, NJ Start Time: 10:00 AM Race Day Registration & Check-in 8:30AM Awards Party at Finish Line 5K Run/Walk (3.1 miles) To participate please complete this form and either mail to the address below or fax to the Arthritis Foundation. Mail : Arthritis Foundation 200 Middlesex Turnpike, Iselin, NJ 08830 Fax: (732) 283-4633 In Store Registration Available at: www.runningco.com
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Transcript of Registration Form Cooper River For More Information: Call the Jingle Bell Run/Walk HOTLINE...
Registration FormCooper River
For More Information:Call the Jingle Bell Run/Walk HOTLINE1-888-467-3112 (in NJ)1-732-283-4300 x [email protected] & Team Opportunities Available!Register Online www.2007jbrwcooperriverpark.kintera.org
Do you have arthritis or a related disease? ___Y ___N
Name: ______________________________ If Yes, what type? ___________________Address: ____________________________ I heard about this event from: _____________________City: ________________________________ State: ________________ Zip: ___________________Age: _______ Gender: _________ Phone Day: ____________________Eve: ___________________Email: _______________________________________________________
I am planning to raise pledges. My pledge goal is $ __________ I have added a donation below to support the Arthritis Foundation
Registration Fee (includes t-shirt, bells & “Beat the Cold” Goodie Bags)$20 prior to 10/15/07$22 through 11/14/07$25 beginning 11/15/07 through day of event
Payment by: ___Cash ___Check ___MC ____Visa ____Amex Acct # __________________________________ Exp: __________
Signature: ______________________________________ * Make checks payable to the Arthritis Foundation
Please check one: ___5K Run ___5K Walk ___VolunteerMy shirt size is: ___S ___M ___L ___XL ___XXLI will Participate ___Individually ___With a team* (minimum of 10 people)*Team captains – Please send in all individual team member’s registration forms together with payments and team roster.
I hereby signify that I understand that the Arthritis Foundation New Jersey Chapter, the Jingle Bell Run/Walk for Arthritis sponsors, the area where I, or my child, run or walk and all other organizationsand persons connected with this event are not to be held responsible for any injuries which I, or my child, may suffer while taking part in this event, or as a result thereof. In this connection, I herebywaive any claim for damages to my person, child or property. I further state that my child or I are in proper physical condition to participate in this event. I grant permission for the organizer to useany photograph or any other record of this event for any legitimate purpose.
Participant’s Signature _____________________________________________________________________________ Date __________________
If Participant is under 18, parent or guardian’s signature ___________________________________________________ Date __________________
Team Name: ____________________________Team Captains: __________________________
Event Sponsors:
Date: December 8, 2007Location: Cooper River Park, Boat House
Pennsauken, NJStart Time: 10:00 AMRace Day Registration & Check-in 8:30AM
Awards Party at Finish Line
5K Run/Walk(3.1 miles)
To participate please complete this form and either mail to the address below or fax to the Arthritis Foundation.
Mail: Arthritis Foundation 200 Middlesex Turnpike, Iselin, NJ 08830
Fax: (732) 283-4633
In Store Registration Available at:
www.runningco.com
