The Ric Ballin 5K Run / Walk

Terry’s Tanzania Trek 6th Annual Terry Berg - 5K Run/Walk Saturday, June 18th, 2016 Ridge Run Park Scenic Drive Entrance – at Wheat Ridge Lane West Bend, WI

8:00 am for Registration and T-shirt pick-up 9:00 am Run/Walk begins.

Rev. Terry Berg was a pastor, husband, father, grandfather, mentor, and good friend to many. Terry was also a Board member of Brick by Brick for Tanzania!, Inc. If it had not been for Terry’s inspiration and passion for this project, Brick by Brick would not be building schools today. Upon his death in November 2010, it was decided to honor his memory by lifting up this important mission.

Brick by Brick for Tanzania!, Inc. is a non-profit that builds schools in Tanzania. Rev. Terry Berg was a strong advocate of Brick by Brick for Tanzania and in 2011 we raised enough money to build a school in his name, ‘The Terry Berg School at Ndoombo.’ Our mission is to continue to raise money to build schools in Tanzania to honor what Terry continues to mean in our lives. For further information visit www.brickbybrickfortanzania.org.

Please mail your registration form by June 15th. Registrations will also be accepted on the day of the event. Bring your pledge form along with cash/checks made payable to Brick by Brick for Tanzania! Inc. to the run/walk.

Directions Hwy 45 to West Bend, exit on Hwy 33 – go west to Scenic Drive – south on Scenic to Wheat Ridge Lane – turn east to park entrance. Cedar Community Memory Care units are now on that corner.

Participants To Do List:

1. Complete the registration form. Include your check for $20.00 made out to Brick by Brick for Tanzania, Inc. Mail by June 15th, 2016 to: Karen Berg 2818 Valley Ave West Bend, WI 53095

2. Collect pledges

3. Join us for the run/walk on June 18th. Bring your pledge form and pledges collected.

Terry’s Tanzania Trek 6th Annual Terry Berg - 5K Run/Walk Saturday, June 18th, 2016 Ridge Run Park Scenic Drive Entrance – at Wheat Ridge Lane West Bend, WI

Entry Form (please print)

Name ______

Address ______

City ______State ______Zip ______Phone Number: ______

T-Shirt Order (circle one) Short-Sleeve T-Shirt

Child: S (6-8) M (10-12) L (14-16)

Adult: S M L XL XXL

Payment Information – Registration includes a t-shirt for each person.

Registration Fee Enclosed $______$20.00 Registration before June 15th $______$25.00 Day of the race fee $______$10.00 Children under 12 $______$50.00 Family Fee

Pledges Collected $______Can be turned in day of the race.

Total Enclosed $______

Please make checks payable to Brick by Brick for Tanzania, Inc.

Neither Brick by Brick for Tanzania, Inc. nor the organizers of the Terry Berg 5K Run/Walk are responsible for any problems or injuries incurred while taking part in this fundraiser. I agree not to bring a lawsuit against Brick by Brick for Tanzania, Inc. or anyone associated with the event. I agree I am the only one responsible for my personal items. I also agree to the use of my name and pictures in any broadcast, telecast, or print media account of this event. In filling out this form, I acknowledge and fully understand my own liability and do accept the restrictions.

______Signature Date ______Parent’s Signature (if under 18) Date 1. Complete the registration form. Include your check for $15.00 made out to Brick by Brick for Tanzania, Inc. Mail by June 15th, 2016, to Karen Berg – 2818 Valley Ave, West Bend, WI 53095 2. Collect pledges 3. Join us for the run/walk on June 18th. Bring your pledge form and pledges collected.

Terry’s Tanzania Trek 6th Annual Terry Berg 5K Run/Walk Saturday, June 18th, 2016 Ridge Run Park Scenic Drive Entrance – at Wheat Ridge Lane West Bend, WI

Pledge Form Pledges are greatly appreciated, but not required to participate. Our goal is for each participant to raise $100 in pledges.

Participants Name: ______

Special Recognition will be given during the Closing Ceremony for anyone who raises over $100 in pledges.

I, ______, have collected the following pledges as a participant of this event.

Name Address Pledge Amount ______$______$______$______$______$______$______$______$______$______$______$______$______

For additional pledges, please use another pledge form. Please collect all pledges and have all checks made payable to Brick By Brick for Tanzania!, Inc. Signature (Guardian if under 18) Print Name