ANNUAL 5K RUN & WALK Sunday, October 19th, Anderson Learning Center (Formerly Nasson) 21 Bradeen Street, Springvale, Maine 9:30am Race Start time **Register Early** First 150 registrants receive a t-shirt! 21 Bradeen Street, Suite 107 Springvale, Maine 04083 telephone: 207.324.0888 ext. 209 fax: 207.324.4822 e-mail: leslie@grahamtastic.org web: www.grahamtastic.org ✂ EXECUTIVE DIRECTOR Leslie Morissette REGISTRATION FORM Name: __________________________________________ Age: ________ M: ______F: ______ Address: _______________________________________________________________________ City: _______________________________ State: ________ Zip: _________________________ Email:_________________________________________________________________________ Check one: Adult ($20 In advance, $25 Day of)________ Teen 13-17 ($15)________ Children 6-12 ($10)____________ Family ($50 Max)___________ Kids, 5 and under when accompanied by a paying adult ($Free)____________ Pledging opportunities available, see below. BOARD OF DIRECTORS Marcel Gagnon-President Donna Perkins-Vice President Beth Brown-Secretary Bobbi Macrum-Treasurer Terri Bronder Kimberlee Caron Lori Chase Lisa Fenderson Are you walking (circle) Y N T-shirt size (circle): S M L running (circle) Y N With dog? (circle) Y N XL (Only available for first 150 Registrants.) In signing this entry, I for myself, my executors, and administrators, release the manager of the race and any affiliates, sponsors, and promoters from any and all liability and damages in case of death or injury received in or in any way associated with this race. Signature (Guardian if under 18) Date Mail registration & fee to Grahamtastic Connection, 21 Bradeen St. Suite 107, Springvale ME 04083 Please bring any additional pledges October 19th Lisa Gray Melody Martin-Robie Justin Mayrand Danielle Moody Nanci Nason Please consider helping us raise pledges! • All individual participants who wish to be recognized as a member of a participating team must use the pledge form on back of this form to register. Denise Pepin • Minimum pledge for teams regardless of participants is $100. AWARDS & RECOGNITION • Minimum pledge for individual raising pledges is $25. 2012 Toyota 100 Cars for Good Winner of a 2013 Toyota Highlander 2011 Parent’s Magazine, August Issue “Power of Parents” 2009 John E. Baldacci, Maine Governor “Exemplary Service Award” 2008 Guest on CNBC’s The Big Idea with Donny Deutsch 2006 WCSH, United Way and TD Bank North “Six Who Care Award” 2002 United Way of York County “Starfish Award” 2001 Rotary Club, Sanford ME • Please appoint a team coordinator who will be responcible for collecting all pledge sheets including parental signature if less than 18 years of age. • Team coordinator will collect pledge sheets and turn them into pledge table day of race or in advance. Advance receipt helps ensure teams get proper credit for pledges raised in order to qualify for winning pizza party. • T-shirts will only be available for first 150 registrants so teams are encouraged to register early. Pledge form on back ANNUAL 5K RUN & WALK Sunday, October 19th, Anderson Learning Center (Formerly Nasson) 21 Bradeen Street, Springvale, Maine 9:30am Race Start time **Register Early** First 150 registrants receive a t-shirt! 21 Bradeen Street, Suite 107 Springvale, Maine 04083 telephone: 207.324.0888 ext. 209 fax: 207.324.4822 e-mail: leslie@grahamtastic.org web: www.grahamtastic.org ✂ EXECUTIVE DIRECTOR PLEDGE FORM Walker/Runners Name:________________________________________________________________________ Team Name (Optional):________________________________________________________________________ Team Coodinator:____________________________________________________________________________ Leslie Morissette In signing this entry, I for myself, my executors, and administrators, release the manager of the race and any affiliates, sponsors, and promoters from any and all liability and damages in case of death or injury received in or in any way associated with this race. BOARD OF DIRECTORS __________________________________________________________________________________________ Signature (Guardian if under 18) Date Marcel Gagnon-President Donna Perkins-Vice President Beth Brown-Secretary Sponsors Name: Bobbi Macrum-Treasurer ___________________________________________________________________________________________ Terri Bronder Kimberlee Caron Amount Pledged: ___________________________________________________________________________________________ Lori Chase ___________________________________________________________________________________________ Lisa Fenderson ___________________________________________________________________________________________ Lisa Gray Melody Martin-Robie ___________________________________________________________________________________________ Justin Mayrand ___________________________________________________________________________________________ Danielle Moody ___________________________________________________________________________________________ Nanci Nason ___________________________________________________________________________________________ Denise Pepin AWARDS & RECOGNITION 2012 Toyota 100 Cars for Good Winner of a 2013 Toyota Highlander 2011 Parent’s Magazine, August Issue “Power of Parents” 2009 John E. Baldacci, Maine Governor “Exemplary Service Award” 2008 Guest on CNBC’s The Big Idea with Donny Deutsch 2006 WCSH, United Way and TD Bank North “Six Who Care Award” 2002 United Way of York County “Starfish Award” 2001 Rotary Club, Sanford ME ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Checks made out to Grahamtastic Connection Total raised: THANK YOU! $25 min individual, $100 min for team