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WORK TO WELLNESS 5K
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2015 KIDS' CHANCE Inc. of Missouri Work To Wellness 5K
Saturday, April 25, 2015
Forum Nature Trail, 2701 Forum Blvd. Columbia, MO 65203
KIDS’ CHANCE of Missouri, a 501(c)(3) not-for-profit organization, is committed to the future of children
who have experienced the emotional and financial trauma following the loss or serious injury of a parent
in a workplace accident. Your generous sponsorship and participation helps to support this cause.
SPONSORSHIP AND WELLNESS BOOTH INFORMATION
BRONZE ($500)
SILVER ($1000)
GOLD ($2000)
To ensure inclusion in any/all sponsorship opportunities, please mail this form and any contributions by March
23, 2015, to Kids’ Chance W2W5K, c/o PEAK Sport and Spine Rehab, 2003 W. Broadway, Ste.105 Columbia,
MO. 65203.
Business Name
Contact
(As you would like it to appear)
Phone #
Email
Amount
Sponsor Type: Bronze, Silver, or Gold
(Please circle one)
Signature
Date
PLEASE SEE COMPLETE SPONSORSHIP LEVEL DETAILS ON BACK
5K REGISTRATION INFORMATION (For online registration go to www.ozarkraces.com/Search/event.aspx?id=31732)
SATURDAY, APRIL 25, 2015 8:00AM | 2701 Forum Blvd. Columbia, MO 65203
Name:
First
Age on Race Day:
Address:
Phone:
Individual: $35
Last
Gender (circle): Male Female
Shirt Size (circle): Unisex S M L XL
* Shirts guaranteed to first 100 participants only
City:
Email Address:
State:
Entry Fee
• Onsite registration for individual participants ends 30 minutes prior to race day start time.
Team of 5: $100
• Online and pre-registration for teams closes Friday, April 17, 2015.
• All teams and every member of the team must be present by 7am on race day.
Total Amount $
PLEASE READ AND COMPLETE WAIVER ON BACK
Zip:
20
15
BRONZE ($500)
SILVER ($1000)
GOLD ($2000)
• LinkedIN & Facebook Update(s)
with Company Name Only
• LinkedIN & Facebook Update(s)
with Company Name & Logo
• LinkedIN & Facebook Update(s)
with Company Name & Logo
• Two Run/Walk Team Registrations
• Two Run/Walk Team Registrations
• Two Run/Walk Team Registrations
• Free Wellness Booth Display
• Free Wellness Booth Display
• Free Wellness Booth Display
• Event Banner Recognition
Company Name & Logo
• Event Banner Recognition
Company Name & Logo
• T-Shirt Recognition
• Race Route Signage
• Event Bag Recognition
• Poster Acknowledgement
2015 WELLNESS BOOTH SCHEDULE
Saturday, April 25, 2015, 7am-10:30am
Booths may include a tabletop display/banner & promotional items.
WAIVER: I know that running is a potentially hazardous activity. I should not enter or run in this event unless I am medically able and properly trained. I agree to abide by any decision of a
race official relative to my ability to safely complete the run. I assume all risks associated with running in this race including, but not limited to falls, contact with other participants, the
effects of weather including high heat and or humidity, the condition of the road and traffic on the course. All potential risks are known and appreciated by me. Having read this waiver and
knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release KIDS' CHANCE Inc. of Missouri Work
To Wellness 5K, all sponsors, their representatives and successor from all claims of liability of any kind, including any claims arising out of negligence of aforementioned parties, arising out
of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.
Furthermore, I release the KIDS' CHANCE Inc. of Missouri Work To Wellness 5K committee and its family members hold harmless from all claims for property damage and bodily injury.
Signature: _____________________________________________Date: __________________
(Signature of parent of guardian if under 18)
Please use a separate form for each entrant
Make Checks Payable to: Kids' Chance W2W5K
Mail to:
PEAK Sport and Spine
2003 W Broadway, Ste. 105
Columbia, MO 65203
Attn: Leslie Earls
Please contact Leslie Earls at learls@pssrehab.com
for event related questions.
Raceday packets will be delivered to team captains and
those registered as individuals prior to the event!
Included in 5k registration:
T-shirt*, post-raceday brunch, and eligibility for prize collection.
5K participants must stay for events' entirety to collect prize(s).