2010 Alzheimer's Race To Remember

& are proud to present

A Race To Remember 7th Annual Grand Slalom Challenge Snowboarders are welcome.

Sunday, January, 10, 2010 Registration: Race begins: Location:

HELPING

8am – 10am 10:30am

Belleayre Mountain Ski Resort Highmount, NY

local families served by the

Alzheimer’s Association Hudson Valley/Rockland/Westchester, NY Chapter Non-refundable Ticket (valued at $58) $25.00 per person including an All Day Lift Ticket and Race Entry OR

To register contact Karen Skelton: 1-800-872-0994 Ext. 107, [email protected] or visit our website: www.alz.org/hudsonvalley Pre-registration ends at 5:00pm on Tuesday, January 6, 2009

Non-refundable Ticket (valued at $88) $40.00 per person including • • • • •

All Day Lift Ticket Race Entry Hot Breakfast Buffet Champion T-Shirt 1 Free Raffle Ticket

(limited to the first 200 people)

are proud to present

A Race To Remember 7th Annual Grand Slalom Challenge RACE INFO: Sunday, January 10, 2010, 10:30 a.m. Race check-in will be from 8:00 a.m. to 10:00 a.m. on the day of the race at the Upper Lodge at Belleayre Mountain. The race will be a grand slalom and challengers will be scored on the best time of two runs. BEGINNERS WELCOME.

Please join us for the special “Alzheimer's Day” Breakfast – 8AM CATEGORIES: Medals will be awarded to the first, second and third place finishers in all categories. ALL RACERS MUST WEAR HELMETS Girls 6-8 years of age

Boys 6-8 years of age

Girls 9-12 years of age

Boys 9-12years of age

Girls 13-18 years of age

Boys 13-18 years of age

Women 19-34 years of age

Men 19-34 years of age

Women 35-49 years of age Women 50 years of age +

Men 35-49 years of age Men 50 years of age +

HOW TO REGISTER: 1. Fill out the reservation form, listing all members of your group 2. Have each participant complete the attached Waiver 3. Mail the completed Reservation/Waivers Form by 5pm Tuesday, January 6th 2010 with the nonrefundable pre-registration contributions of $25.00 per person/Race Entry to: Alzheimer’s Association 2 Jefferson Plaza, Suite 103 Poughkeepsie, New York 12601-4027 ~

FAX (845) 471-8960 All checks should be made out to Alzheimer’s Association Reservations using major credit cards (Visa, Master Card, American Express & Discover), can be accepted over the phone by calling 1 (800) 872-0994 The $25 registration fee is fully tax-deductible

PRE-REGISTERED RACERS DO NOT NEED TO BUY A LIFT TICKET: Belleayre Mountain will provide lift tickets at check-in on the day of the event to ALL REGISTERED PARTICIPANTS (Upper Lodge, Belleayre Mountain Ski Resort, between 8:00 am – 10:00 am on Sunday, January 10, 2010). *Event participants who do not pre-register by 5:00 pm on Tuesday, January 5, 2010 must purchase a full price lift ticket in addition to the $25 Race Entry Fee. All proceeds from the $25.00 per person Race Entry Fee/Donation will benefit the families served by the Alzheimer’s Association, Hudson Valley/Rockland/Westchester, NY Chapter.

A Race To Remember

Reservation/Waiver Form Name: ______________________________________________________

Date of Birth (REQUIRD): _________________

Address: _____________________________________________________________________________________________ City: _____________________________________________ State: _______________________ Zip: _______________ Telephone: __________________________________________________________________________________________ E-Mail: _____________________________________________________________________________________________

TOTAL # persons in your group (ALL info REQUIRED for each): _______________________________

Name

DOB

Age

1._____________________________ 2._____________________________ 3._____________________________ 4._____________________________ 5._____________________________ 6._____________________________ 7._____________________________ 8._____________________________ 9._____________________________ 10.____________________________

__________ __________ __________ __________ __________ __________ __________ __________ __________ __________

________ ________ ________ ________ ________ ________ ________ ________ ________ ________

ALL RACERS MUST WEAR HELMETS

Girls 6-8 years of age

Boys 6-8 years of age

Girls 9-12 years of age Girls 13-18 years of age

Boys 9-12 years of age

Women 19-34 years of age Women 35-49 years of age

1

Boys 13-18 years of age Men 19-34 years of age Men 35-49 years of age

Women 50 years of age +

Men 50 years of age +

Each participant in this event must complete & sign this waiver and return it to the Alzheimer’s Association, Hudson Valley/Rockland/Westchester, NY Chapter prior to the start of the event, to qualify for the lift ticket provided by Belleayre Mountain during registration/check-in. AMOUNT DUE: $_________ ($25 each IF received on/before 5pm 1/6/10 ~ $68 each if received after 5pm 1/5/10) $_________ ($40 package IF received on/before 5pm 1/6/10 ____ Unfortunately, I will not be able to attend, but I have enclosed a $__________ donation to help local Alzheimer families and to help MOVE us closer to a world without Alzheimer’s disease! ____ I have enclosed a check for $_________, made payable to Alzheimer’s Association - Chk#:________ Chk Date:_________ ____ I authorize the Alzheimer’s Association to charge $___________, to my credit card below:  AmEx

 MasterCard

 Visa

 Discover

Exp Date: __________________________

CARD #__________________________________

CVV# (3 or 4 digit verification code): _______________

Authorizing Signature: ______________________________________________________________________

*Payment Information: (all payments are nonrefundable)* Release:

I understand that skiing and snowboarding are sports with inherent risks and that by racing (or otherwise using the day-long lift ticket associated with this event), I am increasing my (my child’s) risk. I do hereby release and discharge the Alzheimer’s Association, Clear Channel, and Belleayre Mountain Ski Center, its Ski School, and all other sponsors and their representatives an d successors from all claims of damages, actions and causes of action arising out of my (my child’s) participation in this race &/or use of the day-long lift ticket associated with this event. I certify that I am (my child is) physically fit and qualified to participate in this race & or to use the lift ticket associated with this event. I further understand that I (my child) might be photographed while participating in this event. I hereby authorize the reproduction of any pictures that might be taken of me (my child), whether they are still or video. I hereby waive all right to compensation for the use of any picture taken, regardless of type of use or exposure chosen. I place no restriction of the use of any photographic likeness and agree to hold harmless all individual photographers assigned as well as discharge the Alzheimer’s Association, Clear Channel, and Belleayre Mountain Ski Center, its Ski School, and all other sponsors and their representatives and successors.

Applicant Signature:

*To be signed by parent or guardian if applicant is under 18 years of age.