In consideration of acceptance of my entry to the Race for Christina, I hereby, for myself, my heirs, my executors and administrators, waive any and all

rights and claims for damages I may have against the Friedreich’s Ataxia Research Alliance (FARA), all participating groups, sponsors, and any individuals associated with this event, their representatives, successors and assigns, and will hold them harmless for any and all injuries and/or damages suffered in connection with this event. I understand that the risks of physical activity include, but are not limited to, fractures, dehydration, heat exhaustion, heat stroke, heart attack and other possible minor and major injuries and I assume full and complete responsibility for any injury or accident which may occur during my participation in this event. Furthermore, I take full responsibility for my actions and will pay for any damages I cause.

If it should become necessary for me to receive medical treatment for any reason during this event, I understand my medical insurance is the only coverage I will receive. I hereby release the representatives, committee members, sponsors, affiliates, all participating groups, and all participating individuals associated with the Friedreich’s Ataxia Research Alliance from any liability related to personal damage or injury.

Photos/General Media Release:

I hereby irrevocably give the Friedreich’s Ataxia Research Alliance perpetual authorization and permission to copyright and/or publish in any media worldwide, any and all video and photographs taken of me without any compensation due to me.

Print Name:

Signature:

FARA’s vision is to cure FA. In just 10 years, FARA has advanced into the treatment era in which they are fostering the development of the most promising discoveries to slow, stop and reverse the damage of this disease. FARA has a robust pipeline of potential treatments at various stages of development and new discoveries on the horizon. We need your support to continue this time sensitive research and development.

-Registration fees are non-refundable

-FARA accepts funds from corporate matching programs (Check with your employer).

T-Shirt Pre-Order

If you are not running, T-shirts are $10 each. Pre-orders for shirts must be submitted before April 15h.

Shirts will be sold day of the walk but sizes cannot be guaranteed.

Children

S ____ M_____ L_____

Adult

S ____ M_____ L_____ XL_____

WITH YOUR HELP,

WE WILL FIND A CURE!

5K Race for Christina

A Walk/RunforFriedreich’s Ataxia

Sunday May 12, 2013

Please come out and support Christina Logan and her fight to raise awareness of Friedrich’s Ataxia. Together we can find a cure!

Registration – 8:30am

Race – 9:30am-1:00pm

Tyler State Park

Newtown, PA 18940

About FARA and FA

Who is FARA?

The Friedreich's Ataxia Research Alliance (FARA) is a national, public, 501(c) (3), non-profit, tax-exempt organization dedicated to curing Friedreich’s ataxia (FA) through research. FARA grants and activities provide support for basic and translational FA research, pharmaceutical/ biotech drug development, clinical trials, and scientific conferences. FARA also serves as a catalyst, between the public and scientific community, to create worldwide exchanges of information that drive medical advances.

What is Friedreich’s Ataxia (FA)?

Friedreich’s ataxia (FA) is a debilitating, life-shortening, degenerative neuro-muscular disorder. About one in 50,000 people in the United States have Friedreich's ataxia. Onset of symptoms can vary from childhood to adulthood. Childhood onset of FA is usually between the ages of 5 and 15 and tends to be associated with a more rapid progression.Late Onset FA (LOFA) can occur anytime during adulthood.

What are the Symptoms of FA?

-loss of coordination (ataxia) in the arms and legs

-fatigue - energy deprivation and muscle loss

-vision impairment, hearing loss, and slurred speech

-aggressive scoliosis (curvature of the spine)

-diabetes mellitus (insulin - dependent, in most cases)

-a serious heart condition (enlarged heart - hypertrophic cardiomyopathy)

FARA is a non-profit organization.

Federal Tax ID#: 52-2122720

Location:

Tyler State Park

101 Swamp Road

Newtown, PA 18940

We will walk/run on a marked trail through Tyler State Park.

The 5K Race is 3.10 miles.

Schedule (Rain or Shine):

Registration8:30am-9:15am

Walk begins at 9:30am

Snack provided Noon-1pm

Please join us for a day of family and fun. There will be a 50/50, entertainment, and beautiful nature provided by Tyler State Park.

Any Questions?

Please e-mail:

Or

Call 267.847.5034

To Register

By mail:

Make all checks payable to‘FARA’

And mail to…

Catherine Logan

715 Walnut StreetApt 2R

Philadelphia, PA 19106

Attn: Race for Christina

Registration Form:

(please submit by April 1st if mailing. One form per person, please list team members)

Name ______

Address ______

City ______

State, Zip ______

Team name ______

Register online at:

Registration for Walk

$20 per person Children Under 18are $10

$25 for Walk Up Registration on 5.12.13

(Please indicate # attending)

Adults Children

Registration includes Bib Number, Race for Christina Live Strong Bracelet, and Race T-Shirt.