Support Mamaroneck-Larchmont Special Education PTA (SEPTA)by Running or Walking in the Village of Mamaroneck2015Turkey Trot on

Sunday, Nov. 22th, 2015
to Runto Raise Money for SEPTA Grants

Sponsorship Form (MUST be completed by ALL Runners)

Name of Participant:______Age as of 11/20/14______
Email:______
Address:______
Telephone:______

Purchase a “Come Run with SEPTA Turkey Trot T-shirt” for $20.00. Proceeds go to SEPTA Grants
T-Shirts will be given out on race day. T-Shirt pre-order deadline is November 15thth (limited available on race day!)

# of t-shirts______Size (please circle your size) Youth: S M L Adult: S M L
Indicate Number of Miles to Be Completed: 1 mile or 3.1 miles (please circle one)

Sponsor Name / Donation Per Mileor Specific Amount / Total Donation

ALL PROCEEDS GO directlyto fund SEPTA grants to public schools in LarchmontMamaroneck. All checks should be made payable to Mamaroneck Larchmont SEPTA. All donations and sponsorship forms should be returned to: SEPTA Treasurer, Patty Wolff,1045Nautilus Lane, Mamaroneck, NY 10543. Donations of check or cash can be turned in at the race or mailed in post completing the race. SEPTA is a registered non-profit PTA under NY State rules and regulations. We must receive a signed sponsorship form and waiver (below) BEFORE the participant begins the race or we will not be able to accept the donation.I understand that the Village of Mamaroneck Turkey Trot is being held on November 22, 2015 and that SEPTA is not an organizer or sponsor of the event and thus not responsible for any conditions or circumstances in connection with the event nor for any participant’s safe participation therein. In consideration of SEPTA’s acceptance of this Sponsorship Form, I, , hereby, for myself, for any of my minor children participating in the event and for my heirs and my estate, agree to hold SEPTA harmless from and to waive and release SEPTA, its board of directors and officers, members, representatives, successors, and assigns from any and all responsibilities, liabilities, rights , causes of action and claims for damages or other costs or expenses I or my child may have arising out of my and/or my minor child’s participation in the Turkey Trot event, including without limitation, any adverse reactions, injuries or illness suffered by me or my minor child in connection with this event. I have read the race entry information provided on the 2015Online Turkey Trot Registration Form and certify my compliance by my signature below. For racers under the age of 18, this form must also be signed by a parent/guardian.
______
Fundraiser Signature 18 or overParent or Guardian Signature if under 18