Empoweringthepoor.org - Empowering the Poor Communities to Self-Reliance and Dignity

	Theme: Rain or Shine, we Run and Walk because every 30 seconds a child dies from malaria in Africa.
	Date: Sunday, April 22nd, 2007
	Where: Downtown Fredericksburg Rappahannock Library (1201 Caroline street) Time: 7:30AM Sponsor, Run, or Walk and you automatically become a WINNER. All participants will receive free T-shirt, sun-visor, refreshments, etc. Register Now!!!! Click here to register Run/Walk Against Malaria

3rdANNUAL EMPOWERING THE POOR 5k MALARIA RUN/WALK FREDERICKSBURG 2008- A community unity event

APRIL 20, 2008 Start@ 8:00 AM

Start and end at the Rappahannock library in DOWNTOWN FREDERICKSBURG-1201 Caroline St
REGISTER NOW and you automatically become a WINNER!-you win the lives of thousands of children who are dying every 30 seconds from malaria in Africa.
Registration with shirt-3 Trophies in each Age group -Refreshments-Course support from Fredericksburg Police- Official Timing-Trainers- Munchies- Malaria sun visors-Malaria Info-
INDIVIDUAL & TEAM REGISTRATION FORM

First Name

Last Name

Age (at event)

Male

female

Walk

Run

I am unable to walk or run but want to support the fight against malaria by making a personal contribution $

Address:

City:

State:

Zip:

E-mail:

Team Name

I am the Team Captain

Phone Number:

WAIVER AND RELEASE (Participant must sign in order to be eligible to participate in event)
I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I AM A VOLUNTARY PARTICIPANT IN THIS EVENT, AND IN GOOD PHYSICAL CONDITION. I HEREBY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR ANY INJURY OR ACCIDENT WHICH MAY OCCUR DURING MY PARTICIPATION IN THIS EVENT OR WHILE ON THE PREMISES OF THIS EVENT, IAND I HEREBY RELEASE AND HARMLESS AND CONVENANT TO FILE SUIT AGAINST EMPOWERING THE POOR, INC., ANY WALK- RUN INDIVIDUAL, AND ANY AFFILIATED INDIVIDUALS, AND ANY WALK-RUN SPONSORS AND THEIR AGENTSAND EMPLOYEES, AND ALL OTHER PERSONS OR ENTITIES ASSOCIATED WITH THIS EVENT FROM ANY LOSS, LIABILITY OR CLAIMS I MAY HAVE ARISING OUT OF MY PARTICIPATION IN THIS EVENT, INCLUDING PERSONAL INJURY OR DAMAGE SUFFERED BY ME OR OTHERS, WHETHER SAME BE CAUSED BY FALLS, CONTACT WITH PARTICIPANTS, CONDITIONS OF THE COURSE, OR OTHERWISE. If I do not follow all the rules of this event, I understand that I can be removed from the Walk-Run. I give my full permission to Empowering The Poor, Inc. and their corporate partners to use any photographs, videotapes, or other recordings of me that are made during the course of this event.

My signature:

I accept conditions

PARENT OR GUARDIAN (if under 18)

Signature:

I accept conditions

Date:

T-Shirt:

School Name

General Registration

$25.00

Student Registration

$15.00

Total Amount Enclosed

Please make your tax-deductible check or money order payable to “EMPOWERING THE POOR” and mail this form along with your check to:

Empowering The Poor
35497 Coyote Trail
Locust Grove, VA 22508

Telephone (540) 424 2705.
Fax (540) 301 0291.

Empowering The poor, Inc. is a charitable organization under section 501 (c) (3) of the U.S Internal Revenue Code. Telephone (540) 424 2705. Fax (540) 301 0291. www.empoweringthepoor.org

Empoweringthepoor.org -2006- All rights reserved. Empowering The Poor, Inc. (ETP) is a non-profit and charitable organization under section 501 (3) of the U.S. Internal Revenue Code. All contributions are tax deductible to the extent permitted by the law. Powered by CQube Data Systems