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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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.