Page 1

register on our web page at:

We THANK Our Key Sponsors: sponsored by:

pre-register by July 6, 2012 t-shirts for pre-registration only

3rd Annual


Sunrise Rotary

Run/Walk for LIFE sponsored by Tom Schneider Agency American Family Mutual Insurance Company and its Subsidiaries Home Office – Madison, WI 53783

Elm Lake Cranberry

on race day $20.00 per person $40.00 per family course: bike path & road awards: top three men and women overall top three finishers in each age group (men & women)

07497 5/12

George Hathaway - Dentist

Saturday July 21, 2012 8:30am start time

John and Patti Moffat

pre-register $15.00 per person $30.00 per family

Centralia Center 220 3rd Avenue South Wisconsin Rapids

age groups: 13 and under 14-19 20-29 30-39 40-49 50-59 60-69 70+ event will take place rain or shine. all runners, walkers, wheelchairs & strollers are welcome. For the safety of all participants PLEASE NO dogs, bikes or skates.

Polio is

• A crippling and potentially fatal infectious disease, polio (poliomyelitis) still strikes children mainly under the age of five in countries in Asia, Africa and the Middle East. • Polio can cause paralysis and sometimes death. Because there is no cure for polio, the best protection is prevention. For as little as 60 cents worth of vaccine, a child can be protected against this crippling disease for life. • It can cause paralysis within hours, and polio paralysis is almost always irreversible. • In the most severe cases, polio attacks the motor neurons of the brain stem, causing breathing difficulty or even death. • Historically, polio has been the world’s greatest cause of disability. • PolioPlus, the most ambitious program in Rotary’s 100-plus year history, is the volunteer arm of the global partnership dedicated to eradicating polio. For more than 20 years, Rotary has led the private sector in the global effort to rid the world of this crippling disease. Today, PolioPlus and its role in the initiative is recognized worldwide as a model of publicprivate cooperation in pursuit of a humanitarian goal. In addition to providing financial and volunteer support, Rotary works to urge support from other public and private sector partners. This includes the campaign to End Polio Now, inspired by the extraordinary challenge grants received from the Bill & Melinda Gates Foundation.

“As an international community, we have few opportunities to do something that is unquestionably good for every country and every child, in perpetuity. Polio eradication is one of these opportunities.” -Dr. Margaret Chan, World Health Organization director-general

pre-register by July 6, 2012

XL-adult x-large

pre-registration cost through July 6, 2012 - Cost July 7, 2012, through day of race $40.00

$30.00 family (one-two adults & unlimited children)

race #

payment date



amount due $

payment type

for office use only.

XXL-adult xx-large

age on July 21, 2012


Date: Date:

Signature of Participant (if 18 years of age and over): Parent/Guardian Signature (if participant is under 18 years of age):

I/We agree that the Sunrise Rotary Run/Walk for LIFE officials have the right to remove me/us from the race if they are of the opinion it is in my/our best interest of the best interest of the Sunrise Rotary Run/Walk for LIFE that I/we be removed. I/We further grant permission to this race and/or agents authorized by them, to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any purpose. I/We have read the foregoing and certify my/our agreement by my/our signature(s) below.

I/We know that running/walking/wheeling in a road race is a potentially hazardous activity. I/We should not enter unless I/we am/are medically able and property trained. I/We also know that, even though police protection will be provided, there may be traffic or other hazards on the course route. I/We expressly assume any and all risks associated with participation in this event but not limited to falls, traffic, contact with another participant, the effects of weather, and condition of the roads. Knowing these facts, and in consideration of your acceptance of my/our entry fee, I/we hereby, for myself/ourselves, my/our heirs, executors, administrators, or anyone else who might claim on my/our behalf, covenant not to sue, and waive release, and discharge the Sunrise Rotary Run/Walk for LIFE and all of its officers, directors, agents, employees, legal representatives and event sponsors from any and all claims of liability for death, personal injury or property damage of any kind or nature out of active or passive negligence of the Sunrise Rotary Run/Walk for LIFE. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.

release and waiver (for all above names listed)

please make checks payable to: Wisconsin Rapids Rotary Foundation Inc. please send registration & check to: Rotary - Sunrise, PO Box 1181, Wisconsin Rapids, WI 54495-1181

I would like to donate $ _______ to support the fight against polio and other Rotary causes.

$ ____________ total race entry amount enclosed

payment $15.00 5k run/walk pre-registration cost through July 6, 2012 - Cost July 7, 2012, through day of race $20.00

shirt sizes - t-shirt for pre-registration ONLY (write number in circle) CH-child S-adult small M-adult medium L-adult large

first name

cell phone


gender (M / F)

work phone

home phone

last name



pre-register online at

event takes place rain or shine!


family member registration

located at

220 3rd Avenue South in Wisconsin Rapids t-shirt for pre-registration ONLY

meet at the

first name last name age on July 21, 2012

individual registration

sponsored by

Run/Walk for LIFE

Sunrise Rotary


3rd Annual

Saturday • July 21, 2012 registration time: 7:00am-8:00am 5K Run/Walk: 8:30am Centralia Center

Rotary Run/Walk for Life  

Saturday • July 21, 2012 Registration time: 7 am-8am 5K Run/Walk: 8:30 am Meet at the Centralia Center located at 220 3rd Avenue South in Wi...

Rotary Run/Walk for Life  

Saturday • July 21, 2012 Registration time: 7 am-8am 5K Run/Walk: 8:30 am Meet at the Centralia Center located at 220 3rd Avenue South in Wi...