WALK-A-THON TO HELP WOUNDED WARRIORS SPONSORED BY…

WALK-A-THON TO HELP WOUNDED WARRIORS
             SPONSORED BY VETERANS FOR COMMON SENSE, INC
              Sunday, March 30, 2008. Siesta Key Public Beach.
                       Time: 9:00AM-1:00PM
YES! I will join with the Florida Veterans for Common Sense, Inc to help raise funds for wounded warriors by
participating in a Walk-a-Thon to benefit Haley House Fund. All net proceeds will be donated to the Haley House
Fund, which is administered by a coalition of veteran advocates, all volunteers. The money from this Walk-a-thon
will be used to provide housing for the visiting families of brain and spinal cord injured veterans wounded in Iraq
and Afghanistan, and other veterans during their rehabilitation at the James A. Haley VA Hospital in Tampa,
Florida. Recovery is often long and painful. The doctors tell us that the presence of a loving family nearby and
involved in the treatment of their loved one speeds recovery and return to a normal life. You can find more about
the Haley House Fund at http://www.haleyhousefund.com/ and the
James A. Haley VA Hospital at http://www1.va.gov/directory/guide/facility.asp?ID=131

I will become a walker/sponsor and solicit my friends, family, and acquaintances to pledge what they can afford for
every mile I walk. (Please Print)

Name: ____________________________________________________
Address:_____________________________________City:___________________State:___ ZIP: _________
Phone:______________________ Email: ______________________
Emergency Phone: ________________________
T-Shirt Size: S M L XL Youth (Circle One)

My check for the registration fee of $5.00, payable to Florida Veterans for Common Sense, Inc is attached. (For
children under 13 there is no registration fee.) All pledges I collect will be forwarded to Florida Veterans for
Common Sense., Inc.

INCOMPLETE OR UNSIGNED REGISTRATION FORMS WILL NOT BE ACCEPTED

WAIVER AND RELEASE: In consideration of the acceptance of my entry into the FLORIDA
WALK-A-THON FOR WOUNDED IRAQ WAR VETERANS sponsored by Florida Veterans for Common
Sense Inc., I intend to legally bind, and do for myself, my executors, administrators, next of kin, and assigns, waive
and release all claims I or my dependents may have against the State of Florida, County of Sarasota, Florida,
Veterans for Common Sense, Inc., and all other sponsors and their event committee, officers, directors, members,
volunteers, employees, agents arising from my participation in the event and its related activities. I consider myself
adequately trained for the Walk. I understand that the walk will take place on Siesta Key Public Beach and I
understand there may be uneven surfaces and other natural hazards. If I or my dependents should suffer an injury as
a result of the event, I authorize the event officials to use their discretion to have me or my dependents transported to
a medical facility and I take full responsibility for this action. I hereby grant full permission to use any photographs,
videotapes, motion pictures, recordings, or any other record of this event for any purpose. I understand the
registration fee is non-refundable.

Signature: ____________________________________              Date: _______________
           (Signature of parent or guardian if under 18)

Make checks payable to Florida Veterans for Common Sense, Inc (Florida Veterans for Common Sense Inc is a
501(c)(4) non-profit, non-partisan all volunteer corporation. Contributions are not tax deductible. Florida Veterans
for Common Sense is registered with the State of Florida to raise charitable funds.)

Mail Checks and this form to Julian Koss: 4180 Via Mirada, Sarasota, FL 34238
For Further Information: contact Julian Koss (941) 923-9280 or EMail: FLveterans@aol.com