2006 WALT DISNEY WORLD®

5K Registration

Walt Disney World®, Florida - Saturday, January 7th, 2006

Participants in wheelchairs are welcome!

REGISTRATION DEADLINE: Saturday, October 1, 2005

Walt Disney World®

5K Registration Fee: $26.25 per participant

Due NOW

Join the A-T Marathoners and Disney characters during the 2006 WALT DISNEY WORLD® Marathon Weekend by participating in Disney's Family 5k Fun Run at 10:00 am at the conclusion of the Half Marathon.

The 5K course will start in the Epcot® Guest Parking Lot and wind through Future World and the eleven nations of the World Showcase.

WALT DISNEY WORLD® 5K Registration fee includes:

● Race entry

● Commemorative T-shirt

● Special Medal

WALT DISNEY WORLD® will allow the A-T Children's Project's participants to use their manual wheelchairs in the 5K Family Fun Run during the Marathon Weekend in January 2006 with a few rules:

1. All 5K participants must be at least 9 years old.

2. The 15-minute per mile pace will be enforced for all participants. Those not keeping pace will be picked up and transported to the finish line.

3. Each participant in a wheelchair must have one adult participant escort (age 18 or older) who will push them. For safety reasons only manual wheelchairs will be allowed on the course.

4. All participants in wheelchairs and their escorts will need to start at the back of the race for safety reasons.

WALT DISNEY WORLD® wants to ensure that the race is safe for everyone involved. If you have any concerns about terrain, weather, crowd control, etc., please contact Jennifer Thornton at the A-T Children's Project who will put you in touch directly with Disney to discuss your concerns.

For everyone's safety, baby joggers/strollers, motorized vehicles, bicycles, inline skates, skateboards, headphones, and animals will be prohibited on the course.

The term "A-T Marathoners" refers to all A-TCP participants registered in any of the WALT DISNEY WORLD® races during the 2006 WALT DISNEY WORLD® Marathon Weekend.

A-TCP Minimum Fundraising Requirement:

$300 per participant

MINIMUM FUNDRAISING REQUIREMENT: You can either donate the $300 personally or raise the $300 through soliciting donations. The A-TCP minimum fundraising requirement must be received by the A-TCP by December 28th, 2005 regardless of your participation in the 5K due to injury, illness, change of plans, etc. (A-T Children's Project, 668 S. Military Trail, Deerfield Beach, Florida 33442) If the entire $300 is not received by the A-T Children’s Project by 12/28/05, then the A-T Marathoner's credit card will be charged the difference to reach a total of $300. 

All money raised must be payable to the A-T Children’s Project and A-T Marathoners must agree to abide by the A-TCP's Fundraising Guidelines, including having all donations sent directly to the

A-TCP office and forwarding any donations given to you personally as soon as you receive them, but no more than 15 days later.

TRAVEL & LODGING: A-T Marathoners are responsible for making and paying for their own travel and lodging arrangements. The A-T Children's Project has arranged for group rates at WALT DISNEY WORLD® Resorts. Visit our Accommodations Page.

FOR THE MINIMUM FUNDRAISING REQUIREMENT YOU WILL RECEIVE:

● Fundraising packet including training manual, donor forms, sample solicitation letters, fundraising tips, 2005 A-T Marathoner t-shirt & practice running tank for new A-T Marathoners. If you would like to host a fundraising event, please click here to fill out the Host an Event Registration form.

● Private A-T Marathoner Email List for updates of donations for

A-T Marathoners, new information, and any help or tools needed for Marathon fundraising activities

● Personal fundraising web page

● Access to have your personal solicitation letters printed in color with A-T patient's picture and mailed to you to send out

● A-T Marathon goody bag including new 2006 A-T Marathon running tank and t-shirt for you and your guest(s) to be picked up prior to race day in the A-TCP Registration Suite on Disney property. (Exact times and location to be announced soon)

● Tickets for you and one guest to all A-TCP private dinner parties OR raise just $500 to receive tickets for your children, too!

A-TCP PRIVATE PARTIES: Pasta Dinner and Celebration Dinner Party - details coming soon. A-T Marathoners and one guest will receive complimentary tickets to each party for which reservations are made. If you raise a minimum of $500, then you, one guest and your children may attend the parties for which you make reservations. Your other guests may attend (subject to space availability): $35 for adults and $20 for children. Reservations and any payments for guests must be made with the A-TCP by December 1, 2005: on the Marathon Party Page  - OR - by calling the A-TCP at 800-543-5728.

PRIZES: To qualify for prizes, all money must be received by the A-TCP by December 28, 2005. Money solicited by married couples who are both registered for the WALT DISNEY WORLD® Marathon Weekend Races will be totaled together and then halved to determine individual totals. Money solicited by parent(s) and minor children who are each registered for a WALT DISNEY WORLD® Marathon Weekend Race will be totaled together and then divided by the number of registered participants to determine individual totals. Money cannot be reassigned from one A-T Marathoner to another. You can, however, decide to fundraise with family or friends as partners and split evenly all funds raised. See Prize Rules for all the details.

EXPENSES: Once you have raised $2000, you will be eligible to receive up to 20% (i.e., $400+) for reimbursement of an A-T Marathoner's expenses for the WALT DISNEY WORLD® Marathon registration, coach airfare, up to 3 nights lodging, and transportation to/from your hotel. Remember, you have the rest of 2005 to raise funds! All money raised must be in accordance with the A-T Children’s Project’s Fundraising Guidelines. Once you have raised $2000, receipts can then be submitted to the A-T Children’s Project for reimbursement of eligible expenses. Click here for the Expense Reimbursement Form to print out and return with your eligible expense receipts. Click here if you need to download the free Adobe Acrobat Reader.

All WALT DISNEY WORLD® 5K Registrations and the

A-TCP Minimum Fundraising Requirement are non-refundable and non-transferable and the WALT DISNEY WORLD® 5K registration fee cannot be transferred between the Half and Full Marathon. Race day registration is not available for A-T Marathoners.

Fundraising Partners: A wheelchair participant and his/her one escort must combine their fundraising efforts as Fundraising Partners - please list both names below. If more than these 2 participants will be combining their fundraising efforts, please provide all the names below:

Separate Registrations & Registration Fees:

Each 5K participant must complete the registration form below and make separate registration payments of $26.25 for each participant.

Last Name

First Name

Address Line 1

Address Line 2 optional

City

State/Province

Select State or Province Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ------------------------------ American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands ++++++++++++++++++ CANADA ================== ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NUNAVAT NOVA SCOTIA ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN NORTHWEST TERRITORIES YUKON TERRITORY  

Country - if other than US

Zip/Postal Code  

Birth date (i.e. January 1, 1953)

January February March April May June July August September October November December ,

Age on race day

Gender

Select One Female Male

Evening Phone (xxx-xxx-xxxx)

Day Phone (xxx-xxx-xxxx)    

Email      

T-shirt size  Select One Small Medium Large X Large XX Large XXX Large

Racing Tank size  Select One Small Medium Large X Large XX Large

My goal is to raise $

in honor of A-T patient(s):

To register select YES Yes I agree to the following waiver:

In consideration of training for and/or participating in this event, I hereby for myself, my heirs, and personal representatives assume any and all rights which might be associated with training and participating in this event. I further waive, release, discharge, and covenant not to sue the A-T Children’s Project, its officers, employees, sponsors, organizers, volunteers, or other representatives, or their successors and assigns, for any and all injuries or damages of any kind whatsoever suffered as a result of training or taking part in this event and/or any related activities. I also agree to the use of any photo, film, or videotape of the event for any purpose.

All Athletes who participate in sports events that take place at the WALT DISNEY WORLD® Resort or Disney's Wide World of Sports® Complex, will be required to complete and sign an individual Disney Sports Waiver Form. This form will be provided to you prior to participating. A parent or legal guardian's signature will be required for participants under the age of 18.

This participant's registration is for (select one):

If the participant is under 18, a parent must complete the participant's name, parent's name, and date below.

Participant's Name

Parent's Name          

Date (xx/xx/xx)        

To register select YES Yes I agree to abide by the A-T Children's Project's Fundraising Guidelines below:

MISSION: The A-T Children's Project only sponsors events and other marketing opportunities that appropriately further its mission to accelerate first-rate, international scientific research aimed at finding a cure and improving the lives of all children with ataxia-telangiectasia.
EVENT HOST REGISTRATION FORM: All event hosts are asked to submit a completed Fundraising Event Registration Form to the A-T Children's Project as a first step in the event planning process. Staff members are available to help hosts complete the form and provide consultation as needed.
PUBLICITY: The A-T Children's Project can assist in coordinating press and media releases.
USE OF NAME OR LOGO: Printed material using the A-T Children's Project's name or logo must be approved in advance.
SUPPLIES: The A-T Children's Project will make its best effort to provide t-shirts, sponsor brochures, invitations, printing, postage, information brochures, banners, balloons, videos, or other fundraising supplies.
CONTRACTS: When financially responsible, The A-T Children's Project must be involved in negotiating and signing contracts.
INSURANCE: The A-T Children's Project will assist the host in obtaining event insurance when necessary.
EXPENSES: Expenses must have advance approval when they are to be paid by the A-T Children's Project. The A-T Children's Project strives to keep expenses less than 25% of funds raised.
INCOME: All checks must be made payable to the A-T Children's Project. A minimum of two people is required to be present at locations where money is collected. Funds must be sent to the A-T Children's Project within 15 days of collecting funds or following an event for accounting purposes and timely acknowledgement letters.
EVENT TICKETS: Advance ticket purchases must be sent directly to the A-T Children's Project.
LAWS: Fundraising events must comply with all relevant federal, state or other laws as necessary. Event hosts should determine if special raffle licenses are required.

Please contact the A-T Children's Project with questions at 800-543-5728 or 954-481-6611, or email:

Aletia Patterson, Fundraising Coordinator
Jennifer Thornton, Executive Director

To register select YES Yes I agree to be personally responsible for the $300 A-TCP Minimum Fundraising Requirement by 12/28/05. I understand that this minimum is due even if I don't participate in the 5K due to injury, illness, change of plans, etc.:

I will either donate the $300 personally or raise the $300 through donations to be received by the A-T Children's Project by December 28th, 2005.

To register select YES Yes I authorize the A-T Children's Project to charge my credit card the difference between what I have raised/donated to reach the $300 Minimum Fundraising Requirement if I have not raised/donated the entire amount by 12/28/05.

NEW? If you are new to the A-TCP, please tell us how you found us:

PRINT THIS PAGE FOR YOUR RECORDS!

PAY ONLINE NOW: Submit this form now to register and to pay the 2006 WALT DISNEY WORLD® registration fee of $26.25 for the 5K.

You will enter our secure 'Donation' web site where you will register and enter your credit card information in the 'Donation' form.

This will be your Registration Fee NOT a donation and will complete your registration process.

If you choose to donate the $300 A-TCP Minimum Fundraising Requirement now, the total to charge is $326.25 ($300 as a donation and $26.25 as your registration fee).

- OR -

PAY BY CALLING THE A-TCP OFFICE: I do not want to pay my registration fee online, but I will click the Submit Button below to hold my registration (our secure web site will automatically open, and that window can be closed), and I will call the A-T Children's Project within one week to give my credit card information for the registration fee.

Hours: 8:30 - 5:30 Eastern time, Monday - Friday at 800-543-5728

My registration information is automatically emailed to the

A-TCP when I click the Submit Button.

Comments:

Deadline is Saturday, October 1, 2005.

PRINT THIS PAGE FOR YOUR RECORDS!

This may take a few moments. Thank you for your patience.

Submit to COMPLETE your registration process and

to PAY registration fees on the VeriSign® 'donation' page 

Click only once. Do not press the "back" or "refresh" buttons while waiting for the VeriSign® site.