SOUTHERN NEW MEXICO DOWN SYNDROME FAMILIES
4th ANNUAL BUDDY WALK®
Saturday, October 29, 2011 Walk Begins at 10:00 AM
Meet on the east side of the Pan American Center
NMSU Campus, Las Cruces, New Mexico
Questions? Call: Tim Query 575-636-3643
(Espańol) 575-636-3644
Detach and Remit
Note: You can also download the registration form on-line at www.snmdsf.org
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Street Address
_____________________________________________________________________________City State Zip Daytime Phone
___ Yes! I will walk to promote appreciation and inclusion of people with Down syndrome.
Your registration donation includes a Buddy Walk® T-Shirt, Walker Gift Bag, Post-Walk Party with food and drinks provided, and support for local programs and national advocacy initiatives.
Registration Donation: Persons with Down syndrome: Free
Adults: $12
Children 7-12 years: $6
Children 6 and under: Free
All registration fees include a Buddy Walk T-Shirt: YS YM YL M L XL XXL
Donation: $______ Number of Walkers: ___
___ No, I cannot participate in the Buddy Walk but would like to promote appreciation and inclusion of people with Down syndrome. Please accept my donation to the Buddy Walk.
Donation: $______
I have enclosed my check, made payable to SNMDSF, for registration and/or donation. Please mail your donation and this registration form before October 22, 2011 to:
SNMDSF
c/o: Tim Query
4637 Nogal Canyon Rd Registrations also accepted up until 9:30 am on the day
Las Cruces, NM 88011 of the event.
Waiver: In consideration of me and/or my minor child being permitted to participate in the Buddy Walk, I hereby–for myself, my heirs and personal representatives–assume any and all risks which might be associated with the event. I further waive, release, discharge and covenant not to sue Southern New Mexico Down Syndrome Families, its officers, employees, sponsors, organizers, volunteers or other representatives or their successors and assigns, for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child as a result of taking part in the events and any related activities. I also authorize the use by Southern New Mexico Down Syndrome Families of any photo, film or videotape taken of me or my minor child at the event for any purpose.
Signature _____________________________________________ Date ____________
THIS REGISTRATION IS NOT VALID UNLESS SIGNED.