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VIVEKANANDA SERVICE  SOCIETY  5K  RUN  WALK     FOR  YOUTH  &  YOUTH  @  HEART!  

ARISE, AWAKE!  STOP  NOT  TILL  THE  “5K”  GOAL  IS  REACHED   The  inaugural  VSS  5K  RUN  WALK  for  the  YOUTH  &  YOUTH  @   HEART  is  a  race  to  raise  funds  and  awareness  for  Vivekananda   Service  Society’s,  an  initiative  of  SRKVS  Alumni,  effort  in   supporting  education,  healthcare,  and  livelihood  empowerment.     These  funds  will  be  deployed  to  empower  the  disadvantaged  and   marginalized  population  in  the  rural  areas  of  Karnataka,  initially   and  eventually  across  India.   On  the  150th  Birth  Anniversary  of  the  Great  Swami  Vivekananda,  we   the  volunteers  of  Vivekananda  Service  Society,  with  the  generous   support  from  Sri  Ramakrishna  Ashram,  Mysore  and  Sri   Ramakrishna  Vidyashala,  Mysore,  are  organizing  the  inaugural  VSS   5K  RUN/WALK  for  the  YOUTH  and  YOUTH@HEART.  We  intend   to  make  this  an  annual  event,  and  eventually  hold  more  races   across  Karnataka  and  India.  The  run  welcomes  people  of  all  ages   and  fitness  levels,  from  walkers  to  elite  runners.     VSS  5K  RUN  WALK  FOR  YOUTH  &  YOUTH  @HEART!   Run  Details:   • • •

Date: January  12th,  2014:  Time:  10:00  A.M   Location:    Vivekananda  Statue,  Cheluvamba  Park,  Mysore     Distance:  5  Kilometers  loop  in  the  area  

Suggested Entry  Fees   • Individuals:  Suggested  minimum  donation  of  Rs.  500/person   • Corporate  teams  (5  individuals):    Suggested  minimum   donation  of  Rs.  5,000/team   TURN  OVER  FOR  APPLICATION  FORM  -­>   Vivekananda  Service  Society  is  a  registered  charitable  organization  and   donations  are  exempted  from  tax  under  section  80G  of  the  Income  Tax  Act.   http://www.vivekanandaservicesociety.in  


VIVEKANANDA SERVICE  SOCIETY  5K  RUN  WALK     FOR  YOUTH  &  YOUTH  @  HEART!  

Run Application   Individual  

Corporate Team  

First  Name:   CORPORATE  TEAM     NAME:   eMail  address:   Mailing  address:   City   State   EMERGENCY  CONTACT  NAME     Any  Allergies?     PAYMENT  METHOD:     CHEQUE   Cheque  details:   Bank/Date/Cheque  No./Acct:     Collected  by:  

Last Name:  

(TEAR BELOW    

Contact No.   PIN:   EMERGENCY  CONTACT  PHONE  NO.  

CASH

TEAR BELOW  

TEAR BELOW  

)

RECEIPT Receipt    No.  

Date:

Received with  thanks  from  Sri/Smt/Chi:  __________________________________________   _____________________________________  towards  entry  fee  to  VSS  5K  FUN  RUN  WALK   for  YOUTH  &  YOUTH  @  HEART!     Vivekananda  Service  Society     Authorised  Signatory   Terms  &  Conditions:  Unless  otherwise  provided  in  connection  with  a  specific  VSS  Event,  once  you  have  entered  an  Event,  your   entry  fees  are  non-­exchangeable,  non-­transferable,  and  non-­refundable,  under  any  and  all  circumstances,  including,  but  not   limited  to,  cancellation  of  the  Event  or  of  your  participation,  or  change  in  the  date,  nature,  or  format  of  the  Event.  An  Event   may  be  cancelled  or  changed  for  any  reason,  including,  without  limitation,  severe  weather  or  other  factors  that  threaten  the   safety  of  participants,  staff,  or  volunteers.  Cancellation  or  change  of  the  date,  nature,  or  format  of  an  Event  may  be  mandated   by  governmental  officials  or  otherwise  be  at  the  discretion  of  VSS.  VSS  reserves  the  right  to  change  the  details  of  the  Event,   such  as  the  date,  start  time,  course,  distance  and/or  amenities  offered  in  connection  with  the  Event.  

Vivekananda Service  Society  is  a  registered  charitable  organization  and   donations  are  exempted  from  tax  under  section  80G  of  the  Income  Tax  Act.   http://www.vivekanandaservicesociety.in  


VIVEKANANDA SERVICE  SOCIETY  5K  RUN  WALK     FOR  YOUTH  &  YOUTH  @  HEART!   Waiver,  Authorization,  and  Publicity  Release   WAIVER  OF  LIABILITY:  I  am  voluntarily  entering  or  agreeing  to  be  a  volunteer  and  participate  at  one   or  VIVEKANANDA  SERVICE  SOCIETY  (VSS)  runs,  races,  classes,  or  other  event(s),  as  well  as  activities   related  thereto  (collectively,  the  “Events”).  I  agree  not  to  enter  into  or  volunteer  at  any  of  the  Events   unless  I  am  medically  able  and  properly  trained.  I  agree  to  abide  by  any  decision  of  an  Event  official   relative  to  my  ability  to  safely  complete  any  Event.   I  recognize  that  participation  in  the  Events  is  a  potentially  hazardous  activity  and  I  willingly  assume   all  risks  associated  with  such  participation,  including,  but  not  limited  to,  falls;  contact  with  other   participants,  spectators  or  others,  or  vehicular  or  other  traffic;  the  effects  of  the  weather,  including   heat  and/or  humidity,  wind,  cold  temperature,  and  wet  or  icy  surfaces;  falling  tree  branches  or  other   overhead  objects;  and  the  crowded  nature  and  other  conditions  of  the  course,  all  such  risks  being   known  and  appreciated  by  me.   Having  read  this  Waiver  and  knowing  these  facts,  and  in  consideration  of  your  acceptance  of  my   application  for  the  Events,  I,  for  myself  and  anyone  entitled  to  act  on  my  behalf,  waive  and  release   VIVEKANANDA  SERVICE  SOCIETY;  the  City  of  Mysore,  its  agencies,  departments,  and  officials;  and  all   sponsors  and  officials  of  the  Events;  and  the  employees,  volunteers,  including  medical  volunteers,  and   other  representatives,  agents,  and  successors  of  each  of  the  foregoing  (the  “Releasees”),  from  present   and  future  claims  and  liabilities  of  any  kind,  known  or  unknown,  arising  out  of  my  participation  in  the   Events,  even  though  such  claim  or  liability  may  arise  out  of  negligence  or  fault  on  the  part  of  any  of   the  Releasees.   I  further  acknowledge  that  VSS  reserves  the  right  to  change  the  details  (such  as  the  date,  start  time,   course,  and  distance)  of,  and  amenities  offered  at,  the  Events  at  any  time  for  any  reason,  and  I  hereby   waive  and  release  any  claims  that  I  may  have  as  a  result  of  any  such  changes.   AUTHORIZATION:  I  grant  to  the  Race  Director  and  Medical  Director  of  the  Events  and  his  designees   permission  to  administer  or  arrange  for  any  medical  assistance  that  they  deem  necessary  or   appropriate  as  a  result  of  my  participation  in  the  Events,  including  without  limitation,  arranging   transportation  to  a  hospital  or  other  medical  facility.  I  also  grant  them  access  to  my  medical  records   and  physicians,  as  well  as  other  information,  relating  to  medical  care  that  may  be  administered  to  me   at  any  such  medical  facility  as  a  result  of  my  participation  in  the  Events.   PUBLICITY  RELEASE:  I  grant  permission  to  the  Releasees  to  use  or  authorize  others  to  use  any   photographs,  motion  pictures,  video  or  sound  recordings,  or  any  other  record  of  my  participation  in   the  Events,  including  my  name,  for  any  purpose  without  remuneration.   GUARDIAN’S  PERMISSION  AND  RELEASE  FOR  MINOR:  If  I  am  or  will  be  applying  for  my  child   under  18  years  of  age  to  participate  in,  or  be  a  volunteer  at,  any  Events,  I  represent  and  warrant  that  I   am  the  parent  or  legal  guardian  of  the  child  and,  as  such,  consent  to  my  child’s  participation  in  the   Events,  and  I  agree  that  the  terms  of  the  foregoing  Waiver,  Authorization,  and  Publicity  Release  as   well  as  the  Rules  of  Competition  and  Terms  and  Conditions  below  apply  equally  to  my  child  and  me   and  any  claims  I  or  my  child  may  have  in  connection  with  the  Events.  I  also  waive  any  derivative   claims  that  relate  to  or  arise  out  of  my  child’s  participation  in  the  Events.   I  have  read  and  agree  to  the  Waiver,  Authorization,  and  Publicity  Release  above,  as  well  as  the  Rules   of  Competition  and  Terms  and  Conditions  below.     _______________________________________   Signature  of  participant   (Must  be  18  or  older)  

_______________________________________ Parent  or  guardian’s  signature    (if  applicant  is  under  18)  

Vivekananda Service  Society  is  a  registered  charitable  organization  and   donations  are  exempted  from  tax  under  section  80G  of  the  Income  Tax  Act.   http://www.vivekanandaservicesociety.in  

Vss youth and youth at heart run walk a5 (1)  

5K RUN  WALK FOR  YOUTH  &  YOUTH  @  HEART! on National Youth Day 12 Jan.

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