2013 Strides of Hope REGISTRATION FOR PARTICIPANTS
Name __________________________________________________ Youth names who are participating with you: ___________________________
_____________________________________________________________
Address _____________________________________________________________________
City _________________ State ______ Zip _____________ Phone___________________
Email ___________________________ Home Church _________________________
Waiver Statement (must be signed): In consideration of the acceptance of my entry to participate in Strides of Hope events, I for myself, my executors, administrators, and assignees, do hereby release and discharge, hold harmless and agree to indemnify the City of Fort Wayne, A Hope Center Pregnancy & Relationship
Resources, and other sponsors for all actions, litigation, claims, damages, losses, liabilities, costs, expenses or penalties (including, without limitation, attorneys’ fees) whatsoever in any manner arising out of or related to my participation in the Strides of Hope Walkathon/5K Run, whether due to my acts or omissions or those of another person. I attest and verify that I have full knowledge of the risks involved in this event
and I am physically fit and sufficiently trained to participate in this event. I agree that A Hope Center may use my appearance at this event for its promotional materials including, without limitation, its website, posters, newsletters, or any other form of communication including, without limitation, digital, video, print, or any other form of media, an unlimited number of times in perpetuity.
____________________________________________________ ________________________________
Signature of Participant Date
____________________________________________________ ________________________________
Signature of parent/guardian if participant is under 18 years Date
Walkathon and 5K Run Join us Saturday, September 21, 2013, rain or
shine, at Shoaff Park, Conklin Pavilion, 6401 St.
Joe Road, Fort Wayne, to bring light to life!
8:30 AM—Registration
9:00 AM—Runner Registration Closes
9:15 AM—5K Runners leave start line
9:30 AM—Walkers leave start line
IHOP Breakfast served after the walk
Grand Prize Drawing & Runner Awards
Two Ways to Register REGISTER online at www.ahcfriends.org and
create a personal fundraising web page that’s free
and easy to use. Raise sponsor pledges via email
and social networks; you can record offline
pledges too.
REGISTER by using this form. Ask sponsors to
fill-in their information below to make a one-time
pledge. Bring this completed form to the
Registration table on the day of the event. You do
not have to collect money; a pledge reminder
will be mailed to sponsors after the event.
5K RUNNERS: $15.00 ENTRY FEE
WALKERS: No fee. Route is 1.8 miles.
TOTAL PLEDGES RAISED $_____________
I cannot participate but would like to support A Hope Center by donating: $_________.
If walking a different day, please mail your sponsor pledges to:
A Hope Center Pregnancy & Relationship Resources
3630 Hobson Road, Fort Wayne, IN 46815
By raising $250 or more in sponsor pledges, you may enter our Grand Prize Drawing. You must be present at park to enter your name.
Check event you are entering: Walkathon 5K Run (If Runner, Complete information to right)
PARENTAL SIGNATURE REQUIRED IF YOU ARE UNDER 18 YEARS OLD
Team Name (if applicable): ____________________________________
Teams of 5 or more sponsored participants are eligible for Team prizes.
Runner Information Date of Birth: ___-____-_____
Gender:
Male Female
Office Use Only:
Fee Paid: ______________
Extra Donation: $________
Bib # ___________________
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Name:_________________________________________ Address:_______________________________________
City/State:______________________Zip:_____________
Phone : ________________________________________
EMAIL: ________________________________________
Pledge: $25 $30 $50 $100 $200 Other: $______
Your sponsor pledges support
these valuable FREE services:
Supportive, nonjudgmental environment
24 hour phone line (969-HELP)
Pregnancy testing
Limited first trimester ultrasounds
Opportunities to learn about the Gospel
Friendship & mentoring with a volunteer advocate
Education on pregnancy, the truth about abortion,
and education on adoption and parenting options*
Material assistance educational program
Fatherhood program
Group educational classes
Post-abortion recovery Bible study & speakers
Community services referrals
Sexual integrity speakers for youth groups and
school classrooms
*A Hope Center is committed to giving accurate
abortion education, but does not perform abortions
or refer clients to abortion facilities.
Four locations to serve:
A Hope Center Main Office 3630 Hobson Road Fort Wayne, IN 46815 A Hope Center at Primetime 3701 S. Calhoun Street, Suite C Fort Wayne, IN 46807 A Hope Center Southwest 4705 Illinois Road, Suite 115 Fort Wayne, IN 46804 A Hope Center at Grabill 13410 Main Street (in Christian Community Health Care Clinic) Grabill, IN 46741
For further information, contact us at:
260-422-3544
www.ahcfriends.org
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2013
Strides of Hope Walkathon & 5K Run
Shoaff Park
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Thank you for your part in supporting a ministry that
exists to provide life-transforming services related to
pregnancy and sexual integrity.
1) REGISTER! Go to www.ahcfriends.org and
register online as a walker or runner. Pre-
registration helps us better organize this fun event.
If you prefer not to register online, then complete
this Registration & Sponsor form and bring it with
you to the event or if you walk on your own, please
mail it to us.
2) ENLIST SPONSORS! By registering online, you
can create a personal fundraising web page that’s
free and easy to use. Raise sponsor pledges via email
and social networks; you can record offline pledges
too. Online sponsors will receive a tax-receipt at
time of donation or they can choose to be sent a
pledge reminder. If you use this printed Registration
& Sponsor form to enlist sponsors, just complete
and bring with you to the park. Your sponsors will
be sent a pledge reminder after the event. Either
way, you do not have to collect money.
3) HAVE A GREAT TIME of fun, fellowship, and
exercise at Shoaff Park as we bring light to life!
8:30 AM—Registration
9:00 AM-5K Run Registration Closes
9:15 AM—5K Runners leave start line
9:30 AM—Walkers leave start line
(This is a timed race, but not a points race.)
RUNNERS ENTRY FEE: $15.00 Three Ways to Register:
Online at www.ahcfriends.org .Online
registration will close 9/14/2013.
Mail us this Registration Form along with entry fee. Must be postmarked by 9/14/2013.
Register and pay entry fee the day of the event at Runners Registration table.
ALL RUNNERS must check-in at the Runners Registration table the day of event to receive their runner bib and route map. Registration closes at: 9:00 AM. 8:30-9:00 AM 5K Runner Registration 9:15 AM 5K Run starts
Awards
Teen Division (18 years and under) Men - 1st, 2nd, 3rd Place
Women - 1st, 2nd, 3rd Place
Open Division (19-39 years) Men - 1st, 2nd, 3rd Place
Women - 1st, 2nd, 3rd Place
Masters Division (40-59 years) Men - 1st, 2nd, 3rd Place
Women - 1st, 2nd, 3rd Place
Grandmasters Division (60 years & over) Men - 1st, 2nd, 3rd Place
Women - 1st, 2nd, 3rd Place
Raise $250 or more in sponsor pledges and
you may enter the Grand Prize Drawing for a
RELEASE DAY SPA PACKAGE gift certificate
from Tranquil Touch Spa! You must be
present at park to enter your name.
Raise $150 or more in sponsor pledges and
receive a Strides of Hope long-sleeved T-shirt!
Restaurant gift certificates to the top FIVE
fundraisers. These will be mailed out after
compilation of fundraising results.
TEAM REGISTRATION
Church Groups, Youth Groups, Sunday School
Classes, Family Groups, or Employee Groups
may register as a Team. To be eligible for Team
prizes, there must be 5 or more participants
with sponsor pledges on your Team. The Team
with most sponsor pledges averaged per Team
Members will receive Komet Hockey tickets for
each Team member. Register your Team online or call Bev at 260-422-3544.
www.ahcfriends.org
Enjoy a pancake and sausage
breakfast served by International House
of Pancakes
IHOP breakfast
served after
your walk or run
Juice and coffee
Farm fresh apples
5K Runners: We encourage you to invest in
this ministry by raising sponsor pledges. Just
go to www.ahcfriends.org to create a personal
fundraising web page or use this Registration
& Sponsor form to enlist sponsors.