Mount Arlington Borough
Mayor’s Wellness Committee
Saturday, October 6th, 2012
In Honor of Officer Wargo all Proceeds will be donated to DARE New Jersey Inc.
PLATINUM SPONSOR - $1,000
Recognition on Finish-Line Signage,
Recognition on MTA Wellness Website Page,
Log on Runner’s T-Shirt
2 Free Runners
GOLD SPONSOR - $750
Recognition on Finish-Line Signage,
Recognition on MTA Wellness Website Page,
Logo on Runner’s T-Shirt
SILVER - $500
Recognition on MTA Wellness Website Page,
Logo on Runner’s T-Shirt
BRONZE - $250
Logo/Name on Runner’s T-Shirt
OTHER WAYS TO SPONSOR
Provide Race Day Giveaways!
Donate Granola Bars, Waters and Gatorades
Please complete form and return to: Mount Arlington Borough
419 Howard Boulevard,
Mount Arlington, NJ 07856
Attention: Leann Phil – 5K Event Coordinator
*Please write all checks out to MAFOP (Mount Arlington Fraternal Order of Police)
Company Name:
Company Contact Person:
Company Address:
Company Phone Number:
Company/Contact Email:
Level of Sponsorship:
Include Check for Sponsorship $
Please provide us with a company logo/name/artwork/business card to be used for your selected advertisement. You may also email all materials and any questions to Leann Phil – 5K Event Coordinator at .
*Deadline for Sponsorships is September 22, 2012
PLATINUM SPONSOR - $1,000
For Platinum Sponsors please fill out this Official Entry Form for your 2 Free Runners
RUNNER 1:
Last Name: First Name:
Street Address:
City: State: Zip Code:
Phone Number: Email:
Gender: M or F Birth Date: Age on Race Day: Shirt Size:
This release and waiver is executed on this date: October 6, 2012. Knowingly, and at my own risk, I am participating in the Mayor’s Wellness 5K Memorial Run/1 Mile Walk. I do hereby waive release any and all claims against the Mayor’s Wellness Committee of the Borough of Mount Arlington, the Borough of Mount Arlington, any and all parties, groups, organizations, volunteers, employees, sponsors, officials and/or representatives involved in the 5K Memorial Run/1 Mile Walk from any claim of injury, including death, that I may incur as a result of my participation in the event. I further hereby certify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate. If, however, as a result of my participation in the 5K Memorial Run/ 1 Mile Walk, I require medical attention, I hereby give consent to authorize medical personnel to provide such medical care as deemed necessary. I further hereby certify that I give the irrevocable right to use my name and/or picture or photograph in all forms, media and manners, without restriction as to changes or alterations, for website, newspaper, advertising, promotion, exhibition, or any other lawful purposes. I waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs.
Applicant Signature (If under 18, parent/guardian signature) Date
RUNNER 2:
Last Name: First Name:
Street Address:
City: State: Zip Code:
Phone Number: Email:
Gender: M or F Birth Date: Age on Race Day: Shirt Size:
This release and waiver is executed on this date: October 6, 2012. Knowingly, and at my own risk, I am participating in the Mayor’s Wellness 5K Memorial Run/1 Mile Walk. I do hereby waive release any and all claims against the Mayor’s Wellness Committee of the Borough of Mount Arlington, the Borough of Mount Arlington, any and all parties, groups, organizations, volunteers, employees, sponsors, officials and/or representatives involved in the 5K Memorial Run/1 Mile Walk from any claim of injury, including death, that I may incur as a result of my participation in the event. I further hereby certify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate. If, however, as a result of my participation in the 5K Memorial Run/ 1 Mile Walk, I require medical attention, I hereby give consent to authorize medical personnel to provide such medical care as deemed necessary. I further hereby certify that I give the irrevocable right to use my name and/or picture or photograph in all forms, media and manners, without restriction as to changes or alterations, for website, newspaper, advertising, promotion, exhibition, or any other lawful purposes. I waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs.
Applicant Signature (If under 18, parent/guardian signature) Date