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DONATE LIFE RUN-WALK “TEAM MIKE MCKAY” Registration Form www.donateliferunwalk.org April 25, 2009 at CalState Fullerton www.mikemckaymemorial.org Health Festival 7am – 2pm EVENT INFORMATION Schedule of Events 7:00 8:15 9:00 9:15 10:00 Registration Donor Ceremony 5K Run 5K/1K Walk Health Festival Free Event T-Shirt Live Entertainment Food and Refreshments Vendors/Free Samples Fitness Trainers Children’s Events Donor Ceremony Bridging Lives Quilt “Circle of Life” Memorial Garden Entry Fee is $20/Registrant. Additional donations collected from this event are to be distributed between the Donate Life organization and the Mike McKay Memorial Foundation Scholarship Fund. Unless specified otherwise, the first $20 collected wi ll go to Donate Life. The next $20 will go to MMMF, and any money collected over $40 will be split between the two non-profit organizations. (Example: A $50 contribution will be split with $25 to Donate Life and $25 to MMMF. ) Note: You may register up to the day of the race. Late or credit card registrations (to the TEAM MIKE MCKAY account) can be completed at www.donateliferunwalk.org . OneLegacy prefers that “Donor Family Teams” register through the Team Captain (Vince McKay.) Late registrations are not guaranteed to receive “Team Mike” T-Shirt and gift package and may cost more than the $20 fee listed above. Fundraising Dinner to be Held at Mexico Lindo Restaurant in Wrightwood on April 22, 2009 BUSINESS AND CORPORATE SPONSORSHIPS ARE AVAILABLE PLEASE CONTACT VINCE MCKAY @ 760-408-0411 FOR ADDITIONAL INFORMATION The Mike McKay Memorial Foundation is a not-for-profit 501(c)(3) organization. Our Federal Tax ID number is 94-3435178. All donations are tax-deductible to the extent allowable by law, and will be publicly acknowledged unless otherwise requested by the donor. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - Entry Form - One Form per Registrant REGISTRATIONS DUE BY APRIL 9, 2009! First Name Last Name M Address (Mailing) Telephone City E-Mail Sex F State Zip Code Age Check One Runner Walker T-Shirt Size (Check One) S M L XL (Signature) XXL Division (Check One) 1213 - 18 19 - 30 Under 31- 40 41- 50 50+ WAIVER & RELEASE Entries submitted without a signed Waiver Form (“WAIVER”) will be returned. THIS WAIVER IMPACTS YOUR LEGAL RIGHTS -PLEASE READ IT CAREFULLY. Your signature above signifies you have read, understand the significance of and agreed to the WAIVER and each of its terms: WAIVER: In consideration of my, and/or my child’s/dependent’s participation in the 2009 DONATE LIFE RUN/WALK (5K/1K) & HEALTH FESTIVAL, to be held on Saturda y, April 25, 2009 on the campus of CALIFORNIA STATE UNIVERSITY, FULLERTON (“EVENT”), on behalf of myself, my child/dependent, all heirs and all assigns, I release and hold harmless the State of California, the California State University Trustees, California State University, Fullerton, the City of Fullerton, OneLegacy, Mike McKay Memorial Foundation, EVENT organizers and sponsors, and their officers, agents, volunteers, employees, affiliates, servants, assigns, successors and heirs from any and all liability, loss, including any injury/death to any person; damage, expense, cost of every nature, and any cause of action (including negligence) arising from and in connection with my and/or my child’s/dependents participation in this EVENT. I and my child/dependent are in good health and able to participate in this EVENT. If I and/or my child/dependent need emergency medical treatment, I agree to be financially responsible for any co sts incurred as a result of such treatment. I and/or my child/dependent are voluntarily participating in this EVENT, and I acknowledge and willingly assume the risk of any possible injury, death or damage my and/or my child’s dependents participation may cause. Further, I grant permission to all of the foregoing to use an y photographs, motion pictures, recordings, and any other record of this event for legitimate purposes. Make Check/Money Order Payable to (and mail to): Runner Fee Donation (Optional) Total Mike McKay Memorial Foundation PO Box 2741 Wrightwood, CA 92397 $ 20 Received $ Deposited Check No $ Amount
"DONATE LIFE RUN-WALK"