ANNUAL 5K RUN & WALK

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: [email protected]
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: [email protected]
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
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