Race Registration Make a Difference ToR participateaRcaec einR the eR 2017gei gRamonsitsr Rochatarta 5Kit Run/Walk,oinon MaAllMa proceedskek from ea the aD RamonDifif Rochafefre 5Ker Run/Walknecnec goe to To participateTo participate in the in the2016 2016 Ramon Ramon Rocha Rocha 5K Run/Walk,5K Run/Walk, All proceeds from the Ramon Rocha 5K Run/Walk go to return this form with payment by noon Oct. 11 to: TheAll Arc proceeds of Livingston-Wyoming from the Ramon Foundation, Rocha 5K Run/Walk which is gothe to returnreturn this thisform form with with payment payment by noon by noon Oct. Oct. 19 to: 19 to: The Arc of Livingston-Wyoming Foundation, which is the The Arc of L-W • Ramon Rocha Run/Walk Thefundraising Arc of Livingston-Wyoming arm of The Arc of Livingston-Wyoming. Foundation, which is the TheThe Arc Arcof L-W of L-W | Ramon | Ramon Rocha Rocha Run/Walk Run/Walk fundraising arm of The Arc of Livingston-Wyoming. 18 Main Street • Mount Morris, New York 14510 fundraising arm of The Arc of Livingston-Wyoming. 18 Main18 Main Street Street | Mount | Mount Morris, Morris, NY 14510NY 14510 The Arc is the area’s largest primary service provider MakeMake checks checks payable: payable The to: ArcThe ofArc Livingston-Wyoming of Livingston-Wyoming for individuals with intellectual and developmental Make checks payable: The Arc of Livingston-Wyoming The TheArc Arcis the is thearea’s area’s largest largest primary primary To register online, visit www.lwarc.org servicedisabilities. provider for Through individuals its residential, with vocational To register online, visit www.lwarc.org/runwalk.htm service provider for individuals with To register online, visit www.lwarc.org/runwalk.htm intellectualrehabilitation,intellectual and anddevelopmental children’s developmental services, transportation and Entry fees (Select one): disabilities.community servicesThrough programs,its residential, The Arc helps to enhance Entry fees (Select one): disabilities. Through its residential, Entry$20.00 fees by (Select Oct. 11 one): $25.00 on race day vocationalthevocational lives rehabilitation,of more rehabilitation, than 1,100 children's children's community members who P $20.00articipate $20.00 by Oct. forby Oct. free19 19 via $25.00 sponsorships $25.00 on raceon race (detailsday day below*) services, transportation,rely on services and each year. Participate for free via sponsorships; details below services, transportation, and Team entry Participate fees: for free via sponsorships; details below communitycommunity services services programs, programs, The TheArc Arc $17.00 $10.00 $10.00 perMonster Monsterperson Mile Mile (non-compeitive, (non-compeitive, no t-shirt)no t-shirt) helps to enhance the lives of more Team entry fees: helps to enhance the lives of more Team(Teams entry must fees: have four or more people & register by Oct. 11) thanthan 1,000 1,000 community community members members who who $17.00 $17.00 per perperson person rely on services each year. (Teams must have four or more people & register by Oct. 19.) rely on services each year. Name: ______(Teams must have four or more people & register by Oct. 19.) Name:Name: ______Team Name (if applicable):______TeamEachTeam member name name (ifmust applicable): (if complete applicable): a registration.______Submit them together. EachEach member member must must complete complete a registration. a registration. Submit Submit them them together. together. Street Address:______StreetStreet address: address: ______City,City, State, State, State, Zip: ZIP: ______ZIP: ______a a Phone:Phone:______h

Email: ______h Email:Email:______c T-shirtT-shirt size: size: S S M M L L X L X L c T-shirt Size: S M L XL o Sex:Sex: M M F F Age Ageon raceon race day: day: ______o Waiver:Sex: I know M that running F a road Age race ison a potentially race day: hazardous______activity. I should Waiver: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am properly trained and medically able. I assume all risks not enter and run unless I am properly trained and medically able. I assume all risks associatedWaiver: I knowwith running that running in this aevent road including race is a but potentially not limited hazardous to: falls, activity.contact with I should Nothing is Impossible associated with running in this event including but not limited to: falls, contact with Nothing is Impossible R othernot enter runners, and the run effects unless of I weatheram properly including trained heat and/orand medically humidity, able.traffic I andassume all Nothing is Impossible R yo

other runners, the effects of weather including heat and/or humidity, traffic and Costumes Welcome! roadrisks conditions,associated all with such runningrisks being in knownthis event and appreciated including bybut me. not Having limited read to: this falls, Costumes Welcome! road conditions, all such risks being known and appreciated by me. Having read this k waivercontact and with knowing other these runners, facts and the in consideration effects of of your weather accepting including my entry, I,heat and/or k waiver and knowing these facts and in consideration of your accepting my entry, I, n n l forhumidity, myself andtraffic anyone and to road act onconditions, my behalf, all waive such andrisks release being The known Arc ofand Livingston- appreciated by Costumes Welcome!

for myself and anyone to act on my behalf, waive and release The Arc of Livingston- l Wyoming, all volunteers and sponsors, St. Mary's Church, the Village of Geneseo, me. HavingWyoming, read all thisvolunteers waiver and and sponsors, knowing St. these Mary's facts Church, and thein consideration Village of Geneseo, of your their representatives and successors from all claims and liabilities of any kind out of - acceptingtheir representativesmy entry, I, for andmyself successors and anyone from allto actclaims on andmy behalf,liabilities waive of any and kind release out of o o myThe participation Arc of Livingston-Wyoming, in this event before, all during volunteers or after. and sponsors, St. Mary’s Church, Geneseo Trio Sponsor a my participation in this event before, during or after. Geneseo Trio Sponsor a the Village of Geneseo, their representatives and successors from all claims and Edition - liabilities of any kind out of my participation in this event before, during or after. Edition - ______m m

Signature______Date W Signature Date W Signature Date / a / ______a Parent______or guardian signature (if under 18) Date Parent or guardian signature (if under 18) Date n Parent or guardian signature (if under 18) Date n R R

Run or Walk for Free! u Run or Walk Runfor Free! or Walk for Free!* u Ask your family and friends to sponsor your TheThe Arc Arcof Livingston-Wyoming of Livingston-Wyoming Ask Askyour your family family and andfriends friends to sponsor to sponsor your your 6 participation in the Ramon Rocha Run/Walk. If you 18 Main18 Main Street Street 6 participation in the Ramon Rocha Run/Walk. If If you you Mount Morris, NY 14510 get sponsorships of $100 or more, we’ll waive your Mount Morris, NY 14510 .facebook.com/TheArcLivW R

get sponsorships of $100 or more, we’ll waive your 1 get sponsorships of $100 or more, we will waive your R

Phone: 585.658.2828 1 registration fee! All pledges must be received before Phone: 585.658.2828 Halloween registrationregistration fee! fee! All All pledges pledges must must be be received received before before Halloween the race starts. The person raising the most money Fax:Fax: 585.658.4109 585.658.4109 www.facebook.com/TheArcLivWyo

thethe race race starts. starts. The The person person raising raising the mostthe most money money will 0 K www will win a Fitbit Charge HR. For a sponsorship form, www.lwarc.orgwww.lwarc.org 0 K winwill a Fitbit.win a FitbitFor a sponsorshipCharge HR. form, For a visitsponsorship lwarc.org form, or www.facebook.com/TheArcLivWyo visit lwarc.orgcall or Jeff call T. Jeff at T. at 585.658.2828 x128. www.facebook.com/TheArcLivWyo

585.658.2828 x.128. Special Register: 9:00am, Race: 10:00am Rd, Geneseo Avon Church, 4 St. Mary’s visit lwarc.org or call Jeff T. at 585.658.2828 x128. Arc The - Benefits Trio of the Geneseo - Music Costume contest Part T-shirts - Electronic timing Prizes Food 2 5 October 22 Saturday, T-Shirts • Electronic Timing • Prizes • Food • Costume Contest • Part of the Geneseo Trio • Benefits The Arc The • Benefits Trio of the Geneseo • Costume Contest Part • Prizes Food Timing • Electronic T-Shirts Rocha 2017 Ramon 5K Run/Walk Edition Halloween October 14 Saturday, 9:00 am Register: Race: 10:00 am Geneseo, NY Road, Avon Church, 4 St. Mary’s Special Register: 9:00am, Race: 10:00am Rd, Geneseo Avon Church, 4 St. Mary’s A 501(c)(3)A 501(c)(3) private, private, not-for-profit not-for-profit organization organization Arc The - Benefits Trio of the Geneseo - Music Costume contest Part T-shirts - Electronic timing Prizes Food 2 5 October 22 Saturday, Our Race RaceRace Par Partnerstners Our race is named in memory of Dr. Ramon M. Rocha, who Our valued partners receive great community exposure. passionately believed in the possibilities of life, and has PleaseOur valued choose partners your level(s) receive and great return with payment to: been an endless source of inspiration for people of all ages communityThe Arc exposure. of L-W •Please Ramon choose Rocha Run/Walk and abilities. It is with honor that we walk - and run - in your18 level(s) Main Street and return • Mount with Morris, payment New to: York 14510 this footsteps. Make Thechecks Arc payable of L-W |to: Ramon The Arc Rocha of Livingston-Wyoming Run/Walk 18 Main Street | Mt. Morris, NY 14510 USATF Finish Line Partner $2,500.00 Make checks payable: The Arc of Livingston-Wyoming The Course Certified • Your banner displayed prominently at the finish line • Your logo on the back of the event t-shirts • FinishYour logo Line on Partner race day literature $2,500 -• Your Four banner free R un/Walkdisplayed registrations prominently at the finish line -• Your Your logo logo on and the link back from of lwarc.orgevent t-shirts to your website (1 year) -• Your Opportunity logo on race to hang day yourliterature banner at the event -• Four Display free table Run/Walk at the registrations event - Your logo and link from lwarc.org to your Web site (1 year) Dr. Ramon Rocha -Gold Opportunity Partner to hang your banner at the event $1,500.00 Our Race Dr. Ramon Rocha -• Display Your logo table on atthe the back event of the event t-shirts Our race is named in memory of Dr. Ramon M. Rocha, “Nada"Nada es Imposible"Impossible” • GoldYour Partnerlogo on race day literature $1,500 who passionately believed in the possibilities of life, (translation: "Nothing is -• Your Four logo free on Run/Walk the back registrations of event t-shirts and has been an endless source of inspiration for people Impossible") were the words -• Your Your logo logo on and race link day from literature lwarc.org to your website (1 year) of all ages and abilities. It is with honor that we walk by which Dr. Ramon M. Rocha -• Four Opportunity free Run/Walk to hang registrations your banner at the event • Display table at the event — and run — in his footsteps. lived. A beloved family man, - Your logo and link from lwarc.org to your Web site (1 year)

- Opportunity to hang your banner at the event

Race Features: respected professor, -Silver Display P tableartner at the event $1,000.00 > (USATF Certified - 5K) •Th Long-sleevee C t-shirtsou forr these first 300 people to register enthusiastic volunteer, and • SilverYour name Partner bolded on the back of the event t-shirts$1,000 • Food and beverages valued community member, -• Your Acknowledgment name bolded on therace back day literatureof event t-shirts

• Medals> S forF fastest runnersNorth by St age group Dr. Rocha leaves behind a -• Acknowledgment Two free Run/Walk on registrationsrace day literature • Your logo and link from lwarc.org to your website (1 year) • Halloween costume contest legacy of hope for people of - Two free Run/Walk registrations 1.5 all ages and abilities. -• Your Opportunity logo and tolink hang from your lwarc.org banner toat yourthe eventWeb site (1 year) • Chip timing - Opportunity to hang your banner at the event Bronze Partner $750.00 "Ramon was a very caring individual, always fighting for Bronze Partner $750 -• Your Your name name on on the the back back of of event the event t-shirts t-shirts those less fortunate," remembers his wife, Doris. -• Acknowledgment Acknowledgment on on race race day day literature literature 2nd St "Volunteerism was his hobby. Ramon was very • One free Run/Walk registration Main St - One free Run/Walk registration optimistic, and people were his priority.” • Your logo and link from lwarc.org to your website (1 year) Highland Rd - Your logo and link from lwarc.org to your Web site (1 year) Center St Foundation Partner $500 Chestnut St “Ramon was a good ambassador for the college,” -F Youroundation name on Partner the back of event t-shirts $500.00 recalls Dr. Lyle Lehman, a colleague at SUNY Geneseo, -• Acknowledgment Your name on the on back race of day the literature event t-shirts • Acknowledgment on race day literature Start F inish 1.5 K “Monster Mile” where Dr. Rocha taught for most of his career. “The Shirt Partner $250 Is a 5K too “scary”? The 1.5K Monster Mile route is department flourished as one of the top undergrad - Your name on the back of event t-shirts Shirt Map PartnerPartner $60$250.00 a non-competitive stroll for kids (and kids at heart) programs in the state and the country.” -• Your Your name name on on course the back map of for the all event participants t-shirts to strut their stuff, show their costumes, and do Map Partner $60.00 some trick or treating along the way (bags included)! At home, Dr. Rocha was a loving father and amazing dad TOTAL PARTNERSHIPS $______to three children, Andrea, Pete, and Carlos. At work • Your name on course map for all participants Race Features: and in the community, he was a driving force for Contact Name: ______- Long-sleeve t-shirts for the first several charitable organizations. He took the lead in TOTAL PARTNERSHIPS______$______establishing Teresa House, a comfort care home for 300 people to register ContactCompany: Name: ______- Food and beverages those who have a terminal illness. He served on the - Medals for fastest runners by age group Board of Directors for The Arc of Livingston-Wyoming. Company:Street ______Address: ______- Halloween costume contest He was president of Geneseo Kiwanis, and worked Street Address:______- Music diligently on many fundraising endeavors, including the City, State, ZIP: ______- Chip timing annual antique sale and the air show. City, State, Zip______Phone: ______Fax: ______Dr. Rocha founded the SUNY Geneseo Ella Shear School Phone:______Fax:______Questions? Questions?Contact ContactJeff Thomas, Jeff Thomas, Public RelationsPublic Relations Director, of Education’s Xerox Center for Multicultural Teacher Email:Email:______Director,at 585.658.2828 at 585.658.2828 x128 x128 or [email protected]. or [email protected]. Education with financial aid and in-kind support of Xerox Foundation and SUNY Geneseo. SponsorshipSponsorship deadline: deadline: October October 2nd, 8th, 2017 2016