About the MPS Society Run/Walk
Thank you for participating in the 14th
annual National MPS Society’s
Run/Walk 2014. Events like this run
will take place in many cities across
the nation to raise awareness and
funds for medical research to find
cures for MPS and related diseases.
MPS and related diseases affect major
organs including the respiratory
REGISTRATION FEES
1 mile Walk/Kid’s Run
$ 10
Pre-registration 5K Run/Walk
$ 15
Day of Registration 5K Run/Walk $ 20
Family of 4 Registration Fee
$ 50
ONLINE REGISTRATION:
www.mpssociety.org
system, heart, bones and nervous
system. Affecting mostly children, it is
caused by the body’s inability to
A Special Thanks to:
produce certain enzymes. At the
present time, there are no cures.
About the National MPS Society
The National MPS Society exists to find
cures for MPS and related diseases.
We provide hope and support for
affected individuals and their families
through research, advocacy, and
SEWELL MOTOR EXPRESS, INC.
awareness of these devastating
diseases.
5K Run Categories & Awards
The 1st, 2nd and 3rd prize men and
women finishers in the following age
categories will receive medallions:
12 and under
13-19
20-29
30-39 40-49 50-59 60 and up
T-SHIRTS
Pre-registrants will receive a race Tshirt on the day of the race (while
supplies last)
Ann A.
Bockrath, DDS
(513)897-0248
Clara’s
Courage
5 K Run / 1
Mile Walk
October 11, 2014
Denver Williams Park
Wilmington, OH
8:00am
Registration/Sign in
9:00am Race
10:00am Awards
Run/ Walk 2014
Official Sponsor Form
Sponsor’s Name, Address or Phone
Amount
Collected
Name: _____________________________________
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Age: ____________
T-shirt Size: ____________
Gender: Male_____ Female _____
Address: _______________________________
City: ________________ST: ____ Zip: _______
Home Phone: ___________________________
E-mail address: __________________________
Work phone: ____________________________
(ASK YOUR EMPLOYER ABOUT A MATCHING
GIFT PROGRAM)
WAIVER OF LIABILITY MUST BE SIGNED
Total $
I agree to participate in the National MPS Society 5K Run/Walk. I
hereby signify that I understand that the National MPS Society, it’s
local volunteer representatives and all other organizations,
persons and sponsors connected with this event are not to be held
responsible for any injuries which I might suffer while taking part in
this event or as a result thereof. In this connection, I hereby waive
any claims or damages to my person or property. I also grant
permission to all the foregoing to use photographs, videos or audio
recordings of the event for any legitimate purpose.
_________________________________________
Signature (parent/guardian if under 18)
Date
ABSENTEE REGISTRATION
I AM UNABLE TO PARTICIPATE BUT PLEASE ACCEPT THIS DONATION
Please print:
Name: _______________________________________________________
Phone ________________
Registration
Form
(please print)
Address: _______________________________________________________________Age
□ 5K
□ 1 mile _________
Participant’s Last Name:_______________________
City:__________________________________ State ___________________ Zip_________________
Detach and mail registration fees to:
Checks must be made payable to the National
MPS Society
Shane Gibson
1128 Old State Rd.
Wilmington,Oh. 45177