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Racin for Mason


Registration Form for Racin for Mason race May 8, 2011, Linn Benton Community College.

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									Racin’ For Mason

                                        Address Correction Required

                                                                      Albany, OR 97321
                                                                      3311 Pacific Blvd SW
                                                                      Mid-Willamette Family YMCA
                                                                                                          For Mas
  Sunday, May 8th, 2011
       Albany, OR

                                                                                                   Ra c

 5 Mile Run/Walk            2:00pm
 event begins at Linn Benton
 Community College (LBCC) track
 (6500 Pacific Blvd. S.W. Albany)

 5 K Run/Walk               2:05pm                                                                          5K
 event begins at LBCC track
                                                                                                          5 Mile
 1 Mile Kids Run            3:30pm                                                                   1 Mile Kids Run
 event held on LBCC track

 Easy Registration:
 * By mail if received by 4/29/11.
                                                                                                     Benefit Run
        Racin’ For Mason
      3311 Pacific Blvd. SW,
        Albany OR 97321
                                                                                                   Mason MacRostie
 * Register on line at
   by 05/02/11.
 * Register at the Mid-Willamette
   Family YMCA until 05/07/11.
 * Race Day Registration
   12:30-1:30pm at LBCC Track.
 * All runners/walkers must
   register to participate.
                                                                                                                                                 Entry Form
         Mason                                                                                            Age Group
                                                                                                          r (kids race)
                                                                                                               Under 13
                                                                                                                       Male Female (circle)                               T - Shirt             Price
                                                                                                                                                                                           ( circle Race)

        MacRostie                                                                                         r
                                                                                                          20 - 24

                                                                                                               13 - 19
                                                                                                                                                                         r mile $30
                                                                                                                                                                         YS 5

                                                                                                                                                                         r K $25
                                                                                                                                                                         YM 5
Mason started having leg pain right after                                                                 25 - 29
                                                                                                                                                                         r $10
                                                                                                                                                                         YL Kids
Thanksgiving 2010. Thinking it was growing                                                                r
                                                                                                          30 - 34
                                                                                                                                                                         S Family (4+)
pains we powered through. After the pain                                                                  r
                                                                                                          35 - 39
started increasing in intensity and frequency                                                                                                                            r $75
                                                                                                          40 - 44
Mason went to the doctors but they couldn't                                                                                                                              r Fee

                                                  Racin’ For Mason
                                                                                                          45 - 49                                                                              Includes
really find anything. On Saturday Dec 18th
                                                                                                          50 - 54                                                        r Race,
everything came to a head. Mason was in                                                                                                                                                       T-shirt &
horrific pain, he was vomiting, couldn't          The top 3 overall winners will receive medals.          r
                                                                                                          55 - 59
                                                                                                                                                                                              1 Raffle tx.
urinate and his left leg was swollen, red, and    Ribbons for top 3 age group winners for both            r
                                                                                                          Please Print
hot. We went to the ER where they found a         male and female. Every contestant receives a
large tumor by ultrasound near Mason's            Racin’ For Mason T-shirt and 1 raffle ticket            Name
bladder. We were sent immediately to              to be entered into a raffle prize drawing of their
Doernbecher's in Portland. When we got to         choosing. Additional raffle tickets will be available
                                                  for sale at the YMCA & the event. Come join the         City, State ZIP
Doernbecher's we were overwhelmed with
everyone's kindness and reciprocal desire to      fun at the finish line after the race for               Phone

find an answer as to what this tumor was and      entertainment, award presentations, and raffle.         E-mail
how we were going to deal with it. Our world     1st 100 entries will receive a race-bag with bottle.          To make a donation please send your check or
                                                                                                                credit card information to the YMCA. Payable
in one second was completely tossed upside                                                                   to the YMCA with a reference to Racin’ for Mason.
down. And so starts our journey down a path                Saturday, May 7th, 2011
                                                                                                          Method of Payment
we never thought we would face......             3:00-5:00pm Packet pickup at the YMCA                    r    Check (payable to YMCA)r

                                                           Sunday, May 8th, 2011                          r
                                                                                                          Visa                                       r Express

                                                 12:30-1:30pm Packet pickup at LBCC track                 r when paying at the YMCA, do not mail cash)
                                                                                                          Cash (Only
                                                              Late Registration                           Credit Card No.                                                          Expire Date

                                                 2:00pm       5 mile run/walk starts
                                                                                                          Signature (Parent, if under 18)
                                                 2:05pm       5 K run/walk starts
                                                                                                          Release Form (Mandatory): Inconsideration of my entry, I for myself, my
                                                 3:30pm       1 mile Kids run starts                      heirs, executors, administrators, and assigns waive, release and discharge
                                                                                                          any and all rights, claims or damages against the Mid -Willamette Family

                                                               Race Management                            YMCA and/or all sponsors or partners, directors, volunteers, employees or

                                                                                                          agents for such parties for all claims of damages, demands, actions
                                                                                                          whatsoever in any manner arising or resulting from my participating in said
                                                              Chris Reese, Organizer                      event. I attest and verify that I have full knowledge of the risks involved in
                                                                                                          the event, that I assume those risks, that I will assume and pay my own
                                                            Kendra Hale, Asst. Organizer                  medical and emergency expenses in the event of an accident, illness or

of the proceeds from Racin’ For Mason                       Craig Swanson, Race Official
                                                                                                          oth er incapacity, and that I am physically fit and sufficiently trained to
                                                                                                          participate in this event and grant the use of photographs and other records
will be given directly to Mason’s family                                                                  of me in the event for any legitimate purpose. -

          for his ongoing care.                                           Signature
                                                                                                          ----------------------------------------------------------    Date

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