printable registration form - 2Myles4Autism

2 4
myles autism
(A 2 Mile Run/Walk to Raise Autism Awareness)
Myles – a 6th grader at Lineville who
has autism – has inspired his
classmates to plan an event to help
raise autism awareness.
SATURDAY,
APRIL 25th, 2015
9:00 a.m. START
Meadowbrook Elementary School
720 Hillcrest Heights
Howard, WI
(Enter through the front of the building)
REGISTRATION
$7.00 per participant or $25.00 household maximum
Registration includes T-shirt, refreshments, entertainment, and a great time!
If you’d like to have a t-shirt for race day,
you must register prior to April 10 th.
Proceeds will provide autism training
for parents and teachers, purchase
technology to support students with
autism, and continue efforts to raise
autism awareness.
Registrations received after April 10th will still receive a t-shirt,
but it will not be available for pick-up on race day and will have
to be picked up at a later date (to be determined).
*New This Year*: You may register and pay online at
www.2myles4autism.weebly.com
FOR MORE INFORMATION
Contact Vanessa Moran at (920) 662-5078; vanemora@hssd.k12.wi.us or
Rachel Brandt at (920 662-9717; rachbran@hssd.k12.wi.us
Or visit www.2myles4autism.weebly.com
Register and Pay Online at www.2myles4autism.weebly.com
or
Return Entries to:
Vanessa Moran (c/o 2Myles4Autism)
Meadowbrook Elementary School, 720 Hillcrest Heights, Green Bay, WI 54313
Make checks payable to: Howard-Suamico School District
To guarantee a t-shirt, please submit by Friday, April 10th.
You can continue to register up through the day of the event.
T-Shirt
Size
Number
Needed
T-Shirt
Size
Number
Needed
Contact Information
Name: ____________________________________
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YM
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Phone: ____________________________________
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XXL
Email: _____________________________________
Address: _________________________________
City, State, Zip: ___________________________
Signature: ____________________________________________ Date: __________________________
I hereby signify that I understand the Howard-Suamico School District, the 2Myles4Autism sponsors, the area where I run or walk and all other organizations and persons
connected to this event are not to be held responsible for any injuries which I may suffer while taking part in this event or as a result thereof. In this connection, I hereby
waive any claim for damages to my person or property. I further state that I am in proper physical condition to participate in this event
Did you know? Autism affects 1 in 68 children, Boys are four times more likely than girls to have autism. There is no medical
cure for autism. Autism is the fastest-growing serious developmental disability in the U.S. (source: autismspeaks.org)