2 nd Teen Pregnancy Prevention Walk/Ride Educate – Develop - Empower

1. M A D F 2nd Teen Pregnancy Prevention Walk/RideEducate – Develop - Empower RAIN or SHINE!!! Making A Difference Foundation, Inc. (MADF) Invites you to walk or ride to bring about awareness to support our Teen Pregnancy Prevention & Leadership Program (TPPLP). Date: Saturday, June 16, 2012 Time: 9:00 am Pre-Registration 9:30 am Youth/Adult Check-in 10:00 am – 1:00 p.m. Walk/Ride All Walkers Welcome Donation: $20 Registration prior to 5/16/12 $15 Youth – pre reg only (17 & under) $25/$20 After 5/16/12 Entry fees non-refundable Walk/Ride Location: Farmington Canal Heritage Trail Start: Goodrich Street End: Skiff St (Stop & Stop) Name:____________________________ Address:__________________________ _________________________________ Phone:___________________________ E-mail: ___________________________ Age: _____________________________ T-Shirt Size: M L XL (Circle Size) Help us Walk/ride-out Teen Pregnancy Mail form(s) & donation(s) to: Making A Difference Foundation, Inc (MADF) c/o Yvonne McCoy P.O. Box 185308 Hamden, CT 06518 Make checks payable to: MADF For more Info Contact:: Yvonne McCoy (203)848-0551 or madf98yam@yahoo.com Waiver: In consideration of this entry being accepted. I do for myself, or any person or concern who may, on my behalf, hereby hold harmless and release Making A Difference Foundation, Inc., all sponsors and volunteers from any and all claims for personal injury, damages arising out of, or connected with, my participation in this event. I attest and verify that I have knowledge of the risks involved in participating in any of the walk and that I am physically fit to participate. ______________________________________________ ____________________________________________ Signature Date Signature of parent/guardian if under 18 of age Date