REGISTRATION FORM 2013

1. Call to ACTCion 5K RUN/1.5 MILE WALK FOR HUNGER AWARENESS REGISTRATION FORM 2013 EVENT INFORMATION Date: Saturday, June 1, 2013 at 8:00 p.m. Race Day Check-in: Saturday, June 1, 2013 at 7:00 a.m.–7:45 a.m. Location of Race: Goucher College, 1021 Dulaney Valley Road, Towson, MD All Proceeds Donated to: Assistance Center of Towson Churches Registration Fee: $25 Minimum for adults and $20 for ages 18 & under Race Number & T-shirt Pick-up: Friday, May 31, 4:00 p.m. to 7:30 p.m. Thompson Hall, Towson Presbyterian Church, 400 W. Chesapeake Ave., Towson, MD 21204 There will be a Timing Clock at the finish line. Prizes will be awarded. REGISTRATION INFORMATION Name: _____________________________________________________________________________________________ Phone: _________ -__________-___________ Email: ____________________________________________________ Address: __________________________________________________________________________________________ _____________________________________________________________________________________________________ Age: _____ T-shirt Size: ___S ___M ___L ___XL ___2XL Method of Payment: _______Cash ____________Check# Total: ___________ Please mark which event you are participating in: ______Run _____Walk Payment Information: The Entry Fee can be in the form of cash or check from you or funds from your sponsors and donors (please see SPONSOR/DONOR FORM). We cannot guarantee T-shirts for Event Day registration. Please make checks payable to: Call to ACTCion. WAIVER FORM All Participants Must Sign the WAIVER Below: In consideration of this entry, I hereby for myself, heirs, executors and administrators waive and release any liability, claims or demands that I may have against any person or persons affiliated with Goucher College, Towson Presbyterian Church and/or the Assistance Center of Towson Churches from the Call to ACTCion Event. I certify that I am physically able to participate in the event. Signature of Participant: ____________________________________________________________ Date: _____________ Signature of Guardian (if participant is under 18): _______________________________ Date: _____________ Please complete the above information, attach payment, and send to the following address: ACTC c/o DotsieBregel 401 Chesapeake Ave. Towson, MD 21204 Web page: www.actconline.info Contact Dotsie: 410-583-1530 (Over)

2. Call to ACTCion 5K RUN/1.5 MILE WALK FOR HUNGER AWARENESS SPONSOR/DONOR FORM 2013 PARTICIPANT INFORMATION Name: ______________________________________________________________________________________ Phone: _________ -__________-___________ Email: ____________________________________________ Address: ___________________________________________________________________________________ ______________________________________________________________________________________________ PARTICIPANT REQUIREMENTS Please collect all sponsor and donor contributions in advance and mail them to the address listed at the bottom of this form. You may also choose to turn them in at the appropriate registration table the day of the Run/Walk. The registration fee can be made by the participant or can be offset by sponsorship funds. It is our hope that participants will exceed the minimum requirement of $25 for adults or $20 for ages 18 and under by raising additional funds through sponsors. SPONSOR INFORMATION SPONSOR NAME AND ADDRESS DONATION AMOUNT CASH/CHECK# 1. ___________________________________________________________________________________________ 2. ___________________________________________________________________________________________ 3. ___________________________________________________________________________________________ 4. ___________________________________________________________________________________________ 5. ___________________________________________________________________________________________6. ___________________________________________________________________________________________7. ___________________________________________________________________________________________8. ___________________________________________________________________________________________9. ___________________________________________________________________________________________ 10.__________________________________________________________________________________________ Please complete the above information, attach payment and send to the following address: ACTC c/o DotsieBregel 401 Chesapeake Ave. Towson, MD 21204