Autism Society of Greater Orlando s 2018 Autism Walk & Family Fun Day **Annual Fundraising Event**

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1 Autism Society of Greater Orlando s 2018 Autism Walk & Family Fun Day **Annual Fundraising Event** The Autism Society of Greater Orlando is hosting its 13 th Annual Autism Walk & Family Fun Day inside the Orange County Convention Center s North Concourse on Saturday, March 31, 2018 from 8:00 AM 12:00 PM. We would like to invite everyone out to support ASGO and the families affected by autism. 100% of the proceeds will stay right here in the Central Florida area. Registration includes: Admission into the event Event t-shirt for all Pre-registered participants by 2/28/2018 Free parking Air conditioned facility Other Activities include: Access to local vendors Kids activities at every vendor booth Raffle & Silent Auction including gift cards, hotel stays and autographed sports memorabilia. Massages Sports Corner with great games and prizes Moon bouncers Special Guests including some favorite characters. Schedule of event: Early package pickup will be held on Friday, 3/30/2018 from 12:00 4:00 PM On-site package pickup/registration will run Saturday, 3/31/2018 from 7:00 AM 10:00 AM Event begins on Saturday, 3/31/2018 at 8:00 AM Opening Ceremonies begin on Saturday, 3/31/2018 at 10:00 AM For additional information, contact ASGO at or via at Donations will be accepted online at

2 ASGO s 13 th Annual Autism Walk & Family Fun Day Participant Registration Form S Saturday, March 31, 2018 TEAM NAME: NAME OF ADULT REGISTERING FAMILY & FOR PACKAGE PICKUP: **This is the individual who is registering for your family and will pick up the family s packages at check in** Street Address City State Zip Code Phone Address Cost: Number of individuals ages 2 17 (includes shirt) X $15.00 = $ Number of individuals 18 and above (includes shirt) X $20.00 = $ Number of VIP Reception (see flyer for details) X $ = $ (NOTE: 4 VIP Reception Tickets Free w/ Team Donations of $1,000 or more due by 3/15/18) Total Amount owed: $ Please place total number of shirts per size that match the number of participants on the form: CS CM CL AS AM AL XL XXL XXXL PLEASE NOTE: T-shirts are guaranteed to those pre-registered by February 28, 2018 Payment method: Cash, checks payable to the ASGO, or Visa/Master Card. If you wish to charge your registration fee, please fill in the information below: I,, hereby authorize the Autism Society of Greater Orlando to charge my credit card number with a v-code of (3 digit number on back of the credit card) with an expiration date of and a zip code of for a total of $. Signature Completed form should be faxed to or mailed to: ASGO 1650 W. Sand Lake Road Ste. 235 Orlando, FL 32809

3 ASGO s Autism Walk & Family Fun Day Fundraising Opportunity for Great Prizes Solving the Puzzle Challenge ASGO challenges each of you to help raise funds that stay right here in our local community. In exchange, we will reward your fundraising efforts with great prizes. Getting involved is simple - please follow these quick steps: 1. Print out the attached Puzzle Piece 2. Name your Puzzle Piece the name of your child/adult with autism 3. Ask your family members, friends, co-workers, etc. to purchase one of the pieces of the puzzle for $25.00 each. The donor can color it in (or ask your child to do it) thereby personalizing each piece of the puzzle. 4. Once you have completed an entire puzzle piece, you will have raised $250 for ASGO. You can then start another puzzle piece. The more puzzle pieces that you sell, the more prizes you will receive. 5. Send in your completed puzzle pieces and donations by 3/15/2018 for tickets to the VIP Reception ($1,000 donations or more) OR bring them to Early Package pickup on Friday, March 30 th OR to the package pickup/registration on Saturday, March 31 st. Turn them in for great prizes. The prizes will continue to grow if you bring in one puzzle piece, you will get the prize in Level 1. If you bring in two puzzle pieces, you will get the prize from Level 1 and the prize from Level 2 and so on. You could walk away with a large amount of prizes. Prize Level 1 ($250 Donation): 12 Free Months of Membership to ASGO Prize Level 2 ($500 Donation): Level 1 Prize PLUS $50 ASGO Bucks to be used on any ASGO ticket, awareness item, etc. (This equates to a 10% credit back to the family) Prize Level 3 ($750 Donation): Level 1 and 2 Prizes PLUS 4 Admissions to 2018 Holiday Party with Early/VIP Entrance Prize Level 4 ($1,000 Donation): Level 1, 2, & 3 PLUS 4 Admission Tickets to the Step Out With The Stars VIP Reception on 3/30/2018 (please see flyer for more details) Please help ASGO meet its fundraising goal of $100,000. We can only do this with your help and support. Thank you for your participation and your support! The Autism Society of Greater Orlando is a 501(c)(3) not for profit organization dedicated to serving the more than 20,000 Central Florida families living with some form of Autism. Every dollar raised at this event will stay here to support our families living with autism today. Please visit our web site at to find out more about autism and our organization.

4 Solving the Puzzle Challenge Team Name : ASGO s AUTISM FUN DAY WAIVER AND WALK & FAMILY RELEASE OF

5 LIABILITY AND ASSUMPTION OF RISK AND INDEMNITY AGREEMENT In consideration of being permitted to participate in the ASGO Autism Walk (the Event ) as a walker, volunteer or in any other capacity, I, for myself and for my heirs, next of kin, assigns and personal representatives: 1. Represent that I am qualified, in good health and in proper physical condition to participate in the Event. If at any time during my participation in the Event I feel like my physical condition no longer allows me to participate safely or I believe the Event becomes unsafe, I will immediately stop my participation. 2. Acknowledge and understand fully that there are risks and dangers of serious bodily injury and death that could result from my participation in the Event. The risks include, but are not limited to, weather, equipment, actions of other people, including coaches, event officials, and other participants and volunteers, spectators, sponsors, event monitors, producers, organizers, police and municipal workers and operators of motor vehicles in or around the area in which the Event will take place. These risks are inherent in athletics and events that involve large numbers of people and take place in public places. Being aware of these risks and dangers, I have voluntarily elected to participate in the Event and I FULLY ACCEPT AND ASSUME ALL RISKS AND ALL RESPONSIBILITY FOR ANY INJURY, LOSSES AND DAMAGES TO PERSON OR PROPERTY THAT I INCUR AS A RESULT OF MY PARTICIPATION IN THE EVENT. 3. HEREBY AGREE NOT TO SUE AND TO RELEASE, DISCHARGE, WAIVE, HOLD HARMLESS AND TO INDEMNIFY The Autism Society of Greater Orlando and it s affiliates and their officers, directors, employees, volunteers, sponsors, advertisers, participants, agents and representatives, and all other sponsors, organizers, volunteers, officials, medical workers, producers, lessors and organizers and any involved municipalities or other public entities and each of the directors, officers, employees, agents representatives, successors, heirs and assigns of any of the above individuals and entities (collectively and individually Releases ) FROM AND AGAINST ALL LIABILITIES, CLAIMS, DEMANDS, LOSSES, DAMAGES, SUITS AND PROCEEDINGS, REGARDLESS OF THE CAUSE, INCLUDING THE NEGLECT OR CARELESSNESS OF ANY RELEASEE, ARISING OR RESULTING FROM MY PARTICIPATION IN THE EVENT. 4. I irrevocably grant to The Autism Society Of Greater Orlando the right and permission to use my recorded voice, image and likeness in any medium including, without limitation, video, photograph, film and tape, for any lawful purpose I have read this agreement and understand that I have given up substantial rights by agreeing to it. I have agreed to this agreement freely and voluntarily without any inducement or assurances of any nature. I INTEND THIS TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY THE LAW, EVEN THOUGH THAT LIABILITY MAY ARISE FROM THE NEGLIGENCE OR CARELESSNESS OF THE RELEASEES LISTED ABOVE, and I agree that if any portion of this agreement is held to be invalid, the remaining portion of the agreement shall continue to be in full force and effect. By Date /, 2018 Witness Signature Date /, 2018 ****Please complete one form for each participant and bring to package pickup No early submission will be accepted.****

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