Registration form 2011onlinebanner by o1D45ZcK


									                                                                                                NONPROFIT ORG.
Joint Urban Ministry Project                                                                    U. S. POSTAGE
38 South Winooski Avenue                                                                            PAID
Burlington, VT 05401                                                                           PERMIT NO. 198
       Run for JUMP                                                                           BURLINGTON, VT

Run or Walk in the 14th year of the event - September 24 at 9:00 am:
The event includes an open 5K Run, a 1K Run for kids under 14, and a 1K Walk. The Run courses start at the
Burlington Waterfront Skate Park and head north on the bike path, and then return. The 1K Walk proceeds
around Waterfront Park on the Boardwalk. The course is flat and offers beautiful views of Lake Champlain and
the Adirondacks. Participants can run or walk and fundraise, fundraise only, or just run/walk. It’s a fun event
for the whole family with many raffle prizes and tasty refreshments!
5K                       Female and Male: 1st place, and 10 year age groups – male/female
1K                       Girl and Boy: 1st, 2nd and 3rd places, ribbons for all participants
Fundraisers              1st, 2nd and 3rd place prizes for both adults and youth for most money raised
Raffles                  Each participant receives a raffle ticket
Free t-shirt             Walker or runner raising more $50 or more, plus entry fee is waived.
Free sweatshirt          Youth (high school age and younger) raising $150 or more, $250 or more for adults

Our beneficiary:
Run for JUMP helps individuals and families in crisis in the greater Burlington area. In 2010, JUMP assisted
55 households per week, including 4,100 people and 1,700 children. For more information about JUMP, Inc.,
call (802)862-4501 or visit
How to fundraise:
Ask your friends, co-workers, and relatives if they would like to support the critical work that JUMP does by
sponsoring you. You can create your own fundraising page and email it to potential supporters by visiting and following the link to “Run for JUMP”. It’s easy, and a quick way to reach out to many
potential sponsors! Or, use the form on the other side of this brochure and bring it with you, along with your
sponsors’ money to registration (before 8:30AM would be great!) on race day. Checks should be made payable
to JUMP, Inc.
Our underwriters are Merchants Bank, Gadue’s Dry Cleaning and
Gravel and Shea, PC
We are very appreciative of the underwriting support of Merchants Bank, Gadue’s Dry Cleaning and
Gravel and Shea. Their generous support assures the success of this event. For more information on these
Burlington businesses, please visit , www., and
                           NOW You can Register Online at
Registration opens in the Waterfront Shelter (by the fishing pier behind the Coast Guard at the end of Lake
Street) at 8:00 am and closes at 8:50 am. Those who have registered online will still need to check-in to sign the
waiver, get their raffle ticket and pick-up free t-shirt/sweatshirt (if eligible). The Run Entry Fee is $15 (GMAA
members - $10). The entry fee is waived (and free t-shirt awarded!) to any walker or runner raising $50 or more.
The Walk Entry Fee is $15 per adult. T-shirts ($15) and sweatshirts ($25) are available for sale. Only runners
may participate in the run; walkers, anything with wheels, and pets are welcome in the walk.
NAME___________________________________________                          Waiver
ADDRESS________________________________________                          :
                                                                         This waiver MUST be signed by all participants or the
                                                                         participant’s parent or guardian.
CITY_______________________________ STATE______
                                                                         In signing this form for myself (or the participant named at left
PHONE____________________________ ZIP___________                         if under 18), I understand and agree to absolve Run For JUMP,
AGE on race day___________    GENDER___________                          JUMP, and all sponsors - be they individuals or organizations,
                                                                         singly or collectively - of all blame for any injury, misadventure,
               (runners only)        (runners only)                      harm, loss or inconvenience suffered in any of the activities
                                                                         associated with this event. I also grant full permission to use my
  Circle one:     5K        1K        1K Walk           Fundraise only   likeness in photographs or videos for any purpose of publicity or
                                                                         promotion with no liability or obligation to me.
         For Official Use: Sweatshirt/T-shirt Size _________
                                                                         signature of participant or participant’s parent or guardian
Questions? Email

   Sponsor Form
Please include sponsor’s printed name and address. All donations are very much appreciated! Please have
sponsors make their checks payable to “JUMP, Inc.” Entry fees are waived for runners/walkers who raise
$50 or more.

Fundraiser’s name _______________________________                        Fundraiser’s age _________
                                                                                                               (if under 14)
   Sponsor’s name                            address (optional for mailing list) donation amount                    cash/ck

1._______________________                   ____________________________          _____________                       ________

2. _______________________                  ____________________________          _____________                       ________

3. _______________________                  ____________________________          _____________                       ________

4. _______________________                  ____________________________          _____________                       ________

5. _______________________                  ____________________________          _____________                       ________

6. _______________________                  ____________________________          _____________                       ________

7. _______________________                  ____________________________          _____________                       ________

8. _______________________                  ____________________________          _____________                       ________

9. _______________________                  ____________________________          _____________                       ________

10. _______________________                 ____________________________          _____________                       ________

11. _______________________            ____________________________               _____________                       ________
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