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Home My WebLink About00 - Presentation - Donate Life - Handout/Proclamation761 W. Kimberly Ave . Placentia, CA 92870 i@SCALIFORNI A~&l SIGN UP & SAVE LIVES! www.donateLIFEcalifornia.org/PassltOn SK/lK RUN/WALK TOGETHER WE ARE MAKING A SOCIAL CHANGE! FAMILY FESTIVAL DO YOU HAVE A PINK DOT ON YOUR DRIVER'S LICENSE OR 10? If not, go here to register as an organ and tissue donor: www.donateLIFEcalifornia.org/PassltOn Then pass this card onto someone else! ENTRY FO RM (Rain or shine no refunds or transfers) Save time and register online at www.Donat e lif e RunWal k.o rg. Online registration ends at midnight on April 27, 2016. You may register on the morning of the race; the fees will increase to $40.00 per person. ATTENDEE INFO AGE ___ _ EVENT (check one) D Walk D Run SEX (check one) D M D F Would you like to be timed? D Yes D No EVENT FEES (check one) $40.00 Day of Event Registration D $37.00 Individual runners and walkers D $27.00 Per person on a team of 4 or more TEAM NAME ______________ _ FIRST NAME ---------------- LAST NAME _______________ _ ADDRESS---------------- CITY/STATE/ZIP _____________ _ PHONE _________________ _ EMAIL ________________ _ PAYMEN T INFO Make check/money order payable to: Donate Life Run/Walk Check# ________ _ Mail registration to Donate Li fe Run/Walk 761 W. Kimberly Ave., Placentia, CA 92870 CREDIT CARD (circle one) MC VISA AMEX CC NUMBER __________ EXP. ___ _ NAMEONCC ______________ _ Are you an organ recipient? If yes, please choose which organ you received: D Heart D Kidney D Liver D Lungs D Pancreas D Small Intestine If you received an organ transplant, wh ich transplant center are you r currently seen at? _______________ _ T-SHIRT SIZE D XS D S D M 0 L D XL 0 2XL D 3XL D 4XL WAI VER & RE L EA SE Entries submitted without a signed Waiver Form ("WAIVER") will be returned. THIS WAIVER IMPACTS YOUR LEGAL RIGHTS-PLEASE READ IT CAREFULLY. Your signature below signifies you have read , understand the significance of and agreed to the WAIVER and each of its terms: WAIVER: In consideration of my, and/or my child's/dependent's participation in the 2016 DONATE LIFE RUN/ WALK (SK/lK) & HEALTH FESTIVA L, to be held on Saturday, April 30, 2016 on the campus of CALIFORNIA STATE UNIVERSITY, FULLERTON ("EVENT'), on behalf of myself, my child/dependent, all hei rs and all assigns, I release and hold harmless the State of California, the California State University Trustees, California State University, Fullerton, the City of Fullerton, OneLegacy, EVENT organizers and sponsors, and their officers, agents, volunteers, employees, affiliates, servants, assigns, successors and heirs from any and all liability, loss, including any injury/ death to any person; damage, expense, cost of every nature, and any cause of action (including negligence) arising from and in connection with my and/or my child's/dependent's participation in this EVENT. I and my child/dependent are in good health and able to participate in this EVENT. If I and/or my child/dependent need emergency medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I and/or my child/dependent are voluntarily participating in this EVENT, and I acknowledge and willingly assume the risk of any possible injury, death or damage my and/or my child's dependent's participation may cause. Further, 1 grant permission to all of the foregoing to use any photographs, motion pictures, recordings, and any other record of this event for legitimate purposes . SIGNATURE --------,'-----DATE __ _ Sk/lk Run /Wa lk Benef it i ng O ne l egacy Fo unda t ion Produce d By: ~ Onel egacy saving lives through organ. eyeS t1ssue donation SATURDAY I APRIL 30 Ca l State Full ert on Int ram u ral Fie ld Be part of history as we attempt to break the Guinness World Record for the most organ transplant recipients at the Donate Life Run/Walk! OFFICIAL ATTEMPT EVERYONE WELCOME Enjoy the Family Fest ival that will include live entertainment, f ood trucks, health screenings, free samples at vendor booths, fitness trainers and enterta i nment for c hildren . Everyone is welcome: ru n ners, walkers, dialysis p at ients, transplant recipients, li vi ng donors, donor families, community members, students and healt h professionals. FORMA TEAM! Register today at www.DonatelifeRunWalk.com Special incentives f or teams of 25 mem bers or more. ---=:1 J rtumc. 0 1Jl k STAh1 FAMILY FESTIVAL DETAILS • Live entertainment: AII-4-0ne, Scott Macintyre • Special Guests: Phillip Pa lmer, Guinness World Records Adjud icator, Gary Bryan -KRTH 101 • Food trucks • Kid Zone • Opportunities to win great prizes • For general questions about the Donate Life Run/Walk, call the Donate Life Run/Walk information line at 213-356-5231 or visit our website www.DonatelifeRunWal k.org • American Red Cross Mobile w i ll be on-site. Call 714-427-2605 or visit redcrossblood .org to make an appo intment. Plea se use sponsor code: "Donatelife" and bring photo ID to donate . SCHEDULE OF EVENTS . if:OO am Registration . 8:15am Opening Ceremony • 9:00am 5K Run 9:15am 5K/1K Walk • 10:00 am Family Festival Begi'"s • 10:30 am Live Entertainment REGISTRATION FEES • $37.00 Individual runners and walkers • $2il..OO Per person on a team of 4 or more • $40.0® Day of tegistration • Online registration ends on April 27, 2016 at midmight • Registerea participants rceceive a free T-shirt • Special incentives for teams of 25 or more 6UINNESS WORLD RECORD Be part of history as we attempt to break the Guinness World Record for the most ~I OFFICIAL W, ATTEMPT organ transplant recipients at the Donate Life Run/Walk! Circle ot Lite G A R D E N To honor a donor, recipient or loved one and inspire others to donate life , the Circle of Li fe Garden will offer the opport u nity to have an 18 x 24 sign w ith a picture and a message placed in the garden for a $50.00 donation. Sign onto www.DonatelifeRunWalk.com and click on Circle of Life Garden for an order form or call the Donate Life Run/Walk infor m ation line at 213-356-5231 to request a form through the mail. Forms and pictures must be received by March 25, 2016. PRESENTING SPONSOR MOSS -ADAMS llP Certi fied Fub bc Accountan ts ! B u sroess Con s ulta n t~ Pro duce d By: ... ..... W. L. BU 11 LER ••• Construction. Inc. St.Joseph ~~hloag He alth /'A Albertsons VDNS. PAVILIONS my favorite local supermarket ()ntt!J~ 21. Discovery ~:re.ga tiiTillJ . ' .... -.\1 American '-:.../ Red Cross ~· . .. KNX1070 NEWSRADIO G REYSTON E S J> E ( I A L T I E S MARRIOTT EUI..LERTON Hoag • Mission • St.Joseph • St.Jude Moss Bros. AUTO GROUP ~ ONE LAMB0A AJ1!$ffi0 Fist_.er.Scientilk 8ran d ~ Allft£(01J1[1 0f HAfPl & I 11! <WHP/l(f£}1S, organ, tissue, marrow ana 6[ooa aonation are Cife-giving acts recognizee{ worCcfwiae as qpression of compassion to tfiose in need"; ana <r.11J-f!F/l(f£}1S, more tfian 121,000 indiviauaCs nationwiae ana more tfian 21,000 in CaCifornia are currentry on tfie nationa[ organ transpCant waiting [ist, ana on average, 22 peopCe aie eacfi aay wfii[e waiting aue to tfie sfiortage of aonatea organs; ana 11/.J-flF/R ... CE}IS, tfie neea for aonatea organs is especia[ry urgen t in J-{ispanic ana }ljrican }lmerican communities; ana 'WJ-{f£CJ(f£}1S, more tfian 600,000 units of 6[ooa per year are neecfea to meet tfie neea in CaCifornia; ana <~f)J{/F/l(f£}1S, at any given time, 6, 000 patients are in neea of vo[unteer marrow aonors; 'W.HP,CJ(CE}IS, a singCe indiviauaC's aonation of tfie fieart, [ungs, fiver, fijaneys, pancreas ana sma[[ intestine can save up to eigfit fives, aonation of tissue can save ana fiea[ tfie fives of up to 50 otfiers; ana a singCe 6[ooa aonation can fie{p tfiree peopCe in neecf; ana 'WJ-{f£(j(f£}1S, mi[[ions of fives eacfi year are savea ana fieaCea 6y aonors of organs, tissues, marrow ana 6Coocf; ana 'W.HP,CJ(CE}IS, tfie spirit of giving ana aecision to aonate are not restrictea 6y age or medica[ conaition; 'WJ-{f£CJ(f£}1S, over twe[ve mi[{ion Ca[ifornians fiave signea up witfi tfie state-autfiorizea ([)onate Life CaCifornia (])onor (]?sgistry to ensure tfieir wisfies to 6e organ ana tissue aonors are fionorecf; ana 'WJ-{f£(j(f£}1S, Ca[ifornia resiaents can sign up witfi tfie !J)onate Life CaCifornia (]?sgistry wfien appfying for or renewing tfieir ariver's ficenses or J([) caras at tlie CaCifornia ([)epartment of :Motor o/efiicCes . .1VOW, 'I!J-{f£(j(f£POCJ?SE, (]3f£ J<T CJ(PSOLV£!1) 'I!J-{Jlq' I, (])iane (]3rooR§ (])b(on, :Mayor of tfie City of Newport (]3eacfi, on 6efiafj of tfie entire :Newport (]3eacfi City Co unci~ ao fiere6y procCaim Jlpri[ 2016 as /((])94_1/j(])O:N}l CJlE £I¥E C}l£IPO(jJJVI}l :M O:NTJ[" in tfie City of :Newport (]3eacfi, ana in aoing so we encourage a[[ CaCifornians to cfiecft "rtPS!" wfien appfying for or renewing tfieir ariver 's ficense or I.([). care( or 6y signing up at www. aoneo/J([)}lcafi(ornia . org IJ.f WITJ.IPSS 'W.HP,CJ(CEOP, I fiave fiereunto set my Iiana ana causea tfie Sea[ of tfie City of :Newport (]3eacfi to 6e a.Jfo';Fa tfiis 12 1/i aay of }lpri~ 2 016. ~row-- :Mayor