The 7Th Annual Fundraising Event Sponsored by LIFE of Mississippi

Saturday, October 31, 2015 @ 10:00 AM

The 7th Annual Fundraising Event Sponsored by LIFE of Mississippi

Benefiting Mississippians with Disabilities

Registration: T-Shirts are only guaranteed for those who register by Friday, October 16, 2015.

Event day registration begins at 9:00 AM.

For more information, contact Robert Donerson at 601-969-4009 or 1-800-748-9398 (V/TTY).

Directions: Take Exit 1A off I-20 West in Vicksburg and follow the signs to the Welcome Center. Parking is available across the street at the AmeriStar Hotel.

Start/Finish Line:This non-competitive event will take place on the old Mississippi River Bridge.

The staging area will be at the base of the bridge behind the Mississippi Welcome Center.

The route will take participants across the bridge and back 3 times equaling 3.1 miles.

Cost: Minimum Individual Registration Fee for the Event is $25.00 per person.

The Registration Fee for Teams (groups/organizations of 5 or more) is $20.00 per person.

Example: You have a Church Group of 5 that you want to sign up, Registration = $100.00

The Goal:For each Individual who registers for event to raise $125.00 in individual sponsorship. For each Teams who registers for event to raise $150.00 or more in total Team registration.

Collect Sponsorships from family, friends, and businesses to support your participation in this incredible event!!!

To Register, Please Complete the Form below and return payment to:

LIFE of Mississippi

Attention: Augusta Smith

1304 Vine Street

Jackson, MS 39202

*Note* Make ALL checks payable to: LIFE of Mississippi

------

Bridging the Gap Registration Form

5K (3.1 miles) Non-competitive Walk/Run

Individual Registration $______Group Registration $______T-Shirt Size (Circle One / Group Indicate Qty)

Quantity ______

______S M L XL XXL XXXL

Name of Group/Organization (Only if Walking as a Group)

Name:______Phone______

FirstMiddle Initial Last

Address:______

StreetCity State Zip

CIRCLE WHICH LIFE OF MISSISSIPPI OFFICE YOU WANT YOUR REGISTRATION & SPONSORSHIP TO SUPPORT:

GREENWOOD MCCOMB BILOXI JACKSON HATTIESBURG TUPELO

All individuals under 18 years of age will be required to be accompanied by a parent or legal guardian.

All participants are required to complete the attached Sponsorship andRelease Form.

Waiver: In consideration of this entry acceptance, I, the undersigned as a participant in the Bridging the Gap’s Walk, Stroll, or Roll-a-thon, waive any and all rights and claims for myself, heirs, executors and administrators of damages that I might have against LIFE of MS, its members or volunteers, and any officials which may indirectly or directly be connected in this Event in case of injuries, loss, or death sustained by my participation. I further state that I am in proper physical condition to participate, and I am not participating against doctor’s advice, nor am I taking medications that would deter my health and participation in the Event.

Signature______Date______

(A parent or legal guardian must sign for all participants under the age of 18)