blast-off-to-kids-wellness-registration-form download your registration form for business sponsor, exhibitor, donation of prize or speaker and email completed form and payment to Brenda Reisch car@childrenatrisk.ca with Topic “Blast off Kids Registration ”
Blast Off To Kids Wellness! Presented by:
ReviveLife Clinic and Children At Risk
Race Director: Dr. Joel Lee Villeneuve, N.D.
Event Organized by: Brenda Reisch car@childrenatrisk.ca
REGISTRATION FORM
Name: ______________________________________________________________________
Address: ____________________________________________________________________
Business Name: ______________________________________________________________
Business Website: ____________________________________________________________
Phone Number: __________Fax Number: __________________________
Email: ______________________________________________________________________
____ Yes I would like to be added to the ReviveLife Monthly Newsletter
I wish to register for participation in BLAST OFF TO KIDS WELLNESS as a:
1. SPONSOR
BRONZE ($300) _______
SILVER ($500) _______
GOLD ($1000) _______
PLATINUM ($1500+) _______
2. Early Bird-EXHIBITOR ($100) Registration before Sept. 13 _______
After Sept. 13 EXHIBITOR ( $125) _______
Early Bird- GOLD EXHIBITOR ($200) Registration before Sept. 13 _______
After Sept. 13 GOLD EXHIBITOR ( $250) _______
3. SPONSOR/EXHIBITOR (available for sponsors who would also like to promote their business at the event. Sponsor the event, and exhibitor fee is waived) _______
(Please note that all Exhibitors must provide proof of liability insurance coverage.)
4. ELECTRICAL- is very limited due to the site location and is on a first come first serve basis ($50). You must supply your own power cord.
5. PRIZE I will donate the following prize (s):
Prize _________________________ Approximate Value _____________________________
Prize _________________________ Approximate Value _____________________________
Prize _________________________ Approximate Value _____________________________
PAYMENT: Total : _____________
Cheque:_______ (Please make payable to “Children At Risk”)
Send to 235 Donald St. Suite 212, Ottawa, Ont. K1K 1N1
Credit Card: _______ Please circle or bold: Mastercard / Visa / AMEX
Card #: ____________________________________ Expiration:___________
Signature/Name on Card:____________________________________________
On behalf of the Children At Risk Ontario, we sincerely thank you for your contribution to this charitable event! All donations and prizes are eligible for tax receipt.
Charitable registration number 10691/3775/RR/0001
Please email completed form and payment to: Brenda Reisch car@childrenatrisk.ca with Topic “Blast off Kids Registration” Or fax 613-741-5530.
To all Gold exhibitors and Sponsors: please send your company logo* in black & white version of eps, corel draw or vector format (pdf may be acceptable in some cases) to car@childrenatrisk.ca
*ALL GOLD EXHIBITORS & SPONSORS WILL HAVE THEIR LOGOS PRINTED ON THE RACE T-SHIRTS!
