I, the undersigned, intending to be legally bound
for myself, my heirs, executors, administrators,
and assigns, hereby waive and release any and all
rights and claims for damages I may now or
hereafter have against the EPDSC and their
respective employees for any and all damages or
injuries which may be sustained by me or my
family arising out of my participation in the
above activity.
I have been informed that the photograph(s)
taken with the
____________________________________may
be used for marketing or other purposes. I
understand that any information obtained during
this inquiry and identified with me will remain
confidential. I also understand that the
photograph(s) may be used in a presentation, but
no names or places of employment will be
referred to in the final presentation. The
photograph(s) will become the property of the
EPDSC where they may be used for future
purposes.
I understand my participation is strictly voluntary
and that I will not receive compensation,
monetary or otherwise, for my participation.
______________________________
Signature
______________________________
Date
The Eastern Pennsylvania Down Syndrome Center is
dedicated to the physical and mental well-being of
ALL persons with Down syndrome and their families.
Our mission is to equip families and individuals
influenced by Down syndrome with the latest medical
advancement, social, emotional and educational
support in order to maximize each individual’s
potential.
Medical Services
Clinical services using a preventive approach are
available. These services include:
• Comprehensive medical assessments for infants,
children and adolescents by one of our physicians.
• Referral of patients to specialists who have an
interest in meeting the needs of individuals with
Down syndrome
• Evaluation by our developmental occupational
therapist
• Collaboration between our medical staff and the
patient’s primary care physician
Family Support
• Provides information about Down syndrome to new
families
• Assists families in locating medical, educational,
recreational and social services
• Connects families that have similar medical and
educational needs
• Provides networking opportunities for families
through our annual social events
For further information about the EPDSC or the
Second Annual 3.21 Run for Down Syndrome, please
contact us at:
Center: 610-402-0184 * 610-402-0187 (fax)
www.epdsc.net
Saturday April 18, 2015
9:00 AM
Lehigh Parkway
Allentown, PA
100% of proceeds will benefit the Eastern
PA Down Syndrome Center
http://www.epdsc.net
https://www.facebook.com/groups/26613510
3173/
Recognition in EPDSC
newsletter
Link and logo on EPDSC
& Race websites
Logo on Race t-shirts
Friend
$25 min
Bronze
$100
Silver
Race Information
$250
Gold
$500
Platinum
$750
Sponsorship Levels
& Benefits
$1,500
Diamond
Sponsorship
The First Annual 3.21 Run for Down
Syndrome will occur at the Lehigh Parkway
in Allentown, PA. The 3.21 mile distance
symbolizes the 3 copies of the 21st
chromosome that causes Down syndrome.
Register early for the best deal! $20 until
March 8, $25 March 9 - April 16, $30 race
day. T-shirts will be given to all participants
who register by April 4, 2014. T-shirts will
be available while supplies last for
registration after April 4, 2014.
Registration Form
□
Run/Walk
Name:
Address:
City:
St:
Zip:__________ Phone ________________
Age: ___ Gender: _____
Recognition on stage
during opening ceremonies
Recognition & logo in
print & broadcast media
Table space at the race
Link, logo, & editorial
copy on EPDSC & Race
websites
Primary sponsor
identification on all Race
print & media
Large & prominently
displayed logo on Race tshirt
Mail sponsorship information to…
EPDSC
6900 Hamilton Blvd.
P.O. Box 60
Trexlertown, PA 18089
Questions?
Contact: Wendy Carney
wcarney15@gmail.com
Prizes will be awarded for top 3 in overall,
age group, and individuals with Down
syndrome.
Course map can be found online at
www.epdsc.net/special-events/3-21-run-fordown-syndrome
Race Day
8:00 AM
9:00 AM
10:30 AM
Onsite Registration
3.21 Mile Run/Walk
Awards Ceremony
Timing & Registration Provided By:
E-mail:
Shirt Size: □S
□M □L □XL
Emergency Contact Name:_________________
Emergency Contact Phone:_________________
Registration Fees
$20.00 Until March 8, 2014
$____
$25.00 March 8 – April 16, 2014
$____
$30.00 Day of Race
$____
**Registration includes t-shirt (before
April 4), refreshments, prizes.
**Submit completed registration form along
with check(s) made payable to:
EPDSC
6900 Hamilton Blvd.
P.O. Box 60
Trexlertown, PA 18089
Online Registration at:
www.brynmawrrunningco.com
(click on events)