2018 Epilepsy 5K Brochure · Sponsor Superheroes The Epilepsy SuperHero 5K Fun Run/Walk is a...
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Info: Call (210) 653-5353 | [email protected] Mission County Park Pavilions Nov 3, 2018 8am Warm Up Sponsor Superheroes The Epilepsy SuperHero 5K Fun Run/Walk is a family- friendly event! After the walk, enjoy food, photos, and games! 100% of the proceeds will benefit the programs & services of the Epilepsy Foundation Central & South Texas. Join us in the fight for a cure as we raise epilepsy awareness and celebrate those affected by epilepsy! Oct 30, 9am-7pm Oct 31, 9am-5pm Nov 1, 9am-7pm at EFCST Main Office SA Area Packet Pick Up: Out of town? Pick up on event day. Wear your favorite SuperHero costume! One per participant Registration Form WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AND INDEMNITY AGREEMENT: In consideration of being permitted to participate in the 2018 Epilepsy SuperHero FUN Run/Walk (the “Event”) as a walker, runner or volunteer, or in any other capacity, I, for myself, my heirs, next of kin, assigns and personal representatives: Represent that I am qualified in good health and in proper physical condition to participate in the Event and that I will stop my participation if I believe this Event becomes unsafe. I acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from my participation in the Event from any cause. Being aware of these risks and dangers, I have voluntarily elected to participate in the Event and I FULLY ACCEPT AND ASSUME ALL RISKS AND ALL RESPONSIBILITY FOR ANY INJURY, LOSSES AND DAMAGES TO PERSON OR PROPERTY THAT I INCUR AS A RESULT OF MY PARTICIPATION IN THE EVENT. I HEREBY AGREE NOT TO SUE AND TO RELEASE, DISCHARGE, WAIVE, HOLD HARMLESS, AND TO INDEMNIFY THE EPILEPSY FOUNDATION CENTRAL & SOUTH TEXAS and their respective officers, directors, employees, volunteers, sponsors, advertisers, participants, agents and representatives FROM AND AGAINST ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, LOSSES, DAMAGES, SUITS AND PROCEEDINGS, REGARDLESS OF THE CAUSE. I agree to permit the use of my name and/or likeness in any record or communication relating to the Event for any legitimate purpose, without compensation or remuneration. I have read this agreement and understand that I have given up substantial rights by agreeing to it. We reserve the right to cancel in extreme circumstances. In that event, there will be no refunds; rather, your registration fee will be considered a donation to the Epilepsy Foundation. First Name Last Name State Zip Phone Age Date of Birth (mm/dd/yyyy) Male Female Emergency Contact Name Phone Company Address City E-mail Team Name Team Captain Adult: S M L XL Child: S M L Preferred Shirt Size: Plus Size Shirt: (Please add $5.00 for plus size shirt) 2XL 3XL I have enough T-shirts! I would like to waive receipt of my T-shirt in order to maximize my contribution. Signature Required Photography by: Beyond Memory | Photography Charmed Life Photography Viewfinder Photography Special Thanks: Allen Family Aranibar Family Barajas Family Cox Family Girouard Family Packard Family Pre-Medical Society of UTSA dr. Azreena thomas, md, faes
Transcript of 2018 Epilepsy 5K Brochure · Sponsor Superheroes The Epilepsy SuperHero 5K Fun Run/Walk is a...
Info:Call (210) 653-5353 | [email protected]
MissionCountyParkPavilions
Nov 3, 20188am Warm Up
SponsorSuperheroes
The Epilepsy SuperHero 5K Fun Run/Walk is a family- friendly event! After the walk, enjoy food, photos, and games! 100% of the proceeds will benefit the programs & services of the Epilepsy Foundation Central & South Texas. Join us in the fight for a cure as we raise epilepsy awareness and celebrate those a�ected by epilepsy!
Oct 30, 9am-7pm
Oct 31, 9am-5pm
Nov 1, 9am-7pm
at EFCST Main O�ce
SA Area Packet Pick Up:
Out of town? Pick up on event day.
Wear your favorite SuperHero costume!
One per participantRegistration Form
WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AND INDEMNITY AGREEMENT: In consideration of being permitted to participate in the 2018 Epilepsy SuperHero FUN Run/Walk (the “Event”) as a walker, runner or volunteer, or in any other capacity, I, for myself, my heirs, next of kin, assigns and personal representatives: Represent that I am qualified in good health and in proper physical condition to participate in the Event and that I will stop my participation if I believe this Event becomes unsafe. I acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from my participation in the Event from any cause. Being aware of these risks and dangers, I have voluntarily elected to participate in the Event and I FULLY ACCEPT AND ASSUME ALL RISKS AND ALL RESPONSIBILITY FOR ANY INJURY, LOSSES AND DAMAGES TO PERSON OR PROPERTY THAT I INCUR AS A RESULT OF MY PARTICIPATION IN THE EVENT. I HEREBY AGREE NOT TO SUE AND TO RELEASE, DISCHARGE, WAIVE, HOLD HARMLESS, AND TO INDEMNIFY THE EPILEPSY FOUNDATION CENTRAL & SOUTH TEXAS and their respective officers, directors, employees, volunteers, sponsors, advertisers, participants, agents and representatives FROM AND AGAINST ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, LOSSES, DAMAGES, SUITS AND PROCEEDINGS, REGARDLESS OF THE CAUSE. I agree to permit the use of my name and/or likeness in any record or communication relating to the Event for any legitimate purpose, without compensation or remuneration. I have read this agreement and understand that I have given up substantial rights by agreeing to it. We reserve the right to cancel in extreme circumstances. In that event, there will be no refunds; rather, your registration fee will be considered a donation to the Epilepsy Foundation.
First Name Last Name
State
Zip
Phone
Age
Date of Birth (mm/dd/yyyy)
Male Female
Emergency Contact Name
Phone
Company
Address
City
Team Name Team Captain
Adult: S M L XL Child: S M L
Preferred Shirt Size:
Plus Size Shirt: (Please add $5.00 for plus size shirt) 2XL 3XL I have enough T-shirts! I would like to waive receipt of my T-shirt in order to maximize my contribution.
Signature Required
Photography by: Beyond Memory | Photography
Charmed Life PhotographyView�nder Photography
Special Thanks: Allen Family
Aranibar FamilyBarajas Family
Cox FamilyGirouard FamilyPackard Family
Pre-Medical Society of UTSA
dr. Azreena thomas, md, faes
Team Captains Volunteers Sponsors
Are you a born leader? Show your team spirit and win awards!
Visit EpilepsyRun.com and click “Form a Team.”
Help raise awareness while helping your community. Groups welcome!
Visit EpilepsyRun.com and click “Volunteer.”
Our event depends on your support to make it a success.
Visit EpilepsyRun.com and click “Be a Sponsor.”
5K SuperHero Roles
Sponsor yourself for $25 or more $25
Ask 3 family members to sponsoryou for $25 or more
$75
Ask 5 friends for $5 each $25
Ask 5 coworkers for $10 each $50
Ask 5 neighbors for $10 each $50
Ask 3 businesses for $25 each $75
Total Raised $300
Participants on average raise $150... You can help double the National Average!
Start a team of family, friends, and colleagues! Collect donations from family and friends!
All contributions are tax deductible.
To donate visit EpilepsyRun.com and click “Donate.”
Get Sponsored! Start A Team! Support the Cause!How You Can Help...
Runners / Walkers
Your choice of
a 5K route (3.1 miles)
or take a shortcut.
Virtual Walkers
Enjoy a noncompetitive route along the roads surroundingthe Missions!
Can’t make it or want to sleep in? Virtual walkers receive all the benefits of participating without having to be there on the big day!
Leashed dogs, strollers, families, joggers and walkers are all welcome!
Billing Zip Code________
I support the fight to stop seizures! I want to be part of the solution! My donation of $____________ makes a difference!
Completed registration forms & payment may be mailed or dropped off at:
Epilepsy Foundation Central & South Texas8601 Village Dr., Ste. 220San Antonio, TX 78217
[email protected] | (210) 653-5353
Register Online or by Mail! Register online at EpilepsyRun.com.
Register by October 20, 2018 to be guaranteed a t-shirt.Same day registration begins at 7:00am on November 3, 2018at $45 for Adult Registration and $25 for Youth Registration.
ADULT REGISTRATION FEE
YOUTH (18 & UNDER) REGISTRATION FEE
VIRTUAL PARTICIPANT FEE Sleep In For A Cause Virtual Walker
Includes shipping fee. (Shirts shipped after the event) OTHER FEES
Plus Size Shirt Fee (2XL – 3XL)
I would like to purchase additional shirtPlease circle desired size(Limited to one per registration, offer expires 10/20/2018Size: Adult S M L XL Child S M L
Early Bird (until August 3, 2018) Pre Registration
Early Bird (until August 3, 2018) Pre Registration
$25$35
$15$20
$30
$5
$10
Registration & Donations
Register Online at EpilepsyRun.com
___Check enclosed (make checks payable to EFCST)
Card Number________________________________
Expiration Date ___/____
Signature___________________________________Cardholder Name_____________________________
CVC ______
Payment Method
Registration Fee Donation
Total
$_______$_______$_______
$
Additional Fees
I have enough T-shirts! I would like to waive receipt of my T-shirt in order to maximize my contribution.
