2013 Benefit Walk

To make a Donation in
memory of Alicia Cooper:

This event is being held in memory of Alicia Cooper, a
New Philadelphia 17-year old who passed away on
January 3, 2010 from Aplastic Anemia in the Cleveland Clinic
Children’s Hospital, only 2-1/2 months after being
diagnosed.
Aplastic Anemia is a bone marrow failure disease that
affects 1 in 3 million people every year in the United States.

Proceeds will benefit
The Akron Children's Hospital.

Submit Fee via Pay
Pal:

Download a printable flyer


Your name:



Your email address:


Comments:

Contact Webmaster:

Fill out an entry form below or:
Print and Mail Entry Form Here
along with a check or money order for the entry fee to:

Alicia Cooper Memorial P.O. Box 442, New Philadelphia, OH 44663
Geib Funeral Center, 5600 N. Wooster Ave., Dover
Linn-Hert-Geib Funeral Home, 116 2nd Street NE, New Philadelphia

If you wish to learn more about being a sponsor,
Click HERE for information.
Click HERE for a sponsor form.

You do not need a
PayPal account,
PayPal accepts credit
cards, debit cards or
checking information

Saturday September 21st @ 10 AM
Registration begins @ 8:30 AM
Entry Fee $15 by August 26, 2013
$20 after and including the day of the walk.

The proceeds from the 2013 benefit walk will be
going to the Akron Children's Hospital

Walk Run Entry Form

* Required Field

Please note, your application
will not be processed until
payment is received. After
submitting this form, you may
submit payment via PayPal.

If paying for multiple entrants,
list all names at time of
payment.

By submitting this form you are agreeing to the liability waiver:

Waiver: I, the undersigned, realize that running a road race is a potentially hazardous activity.
I should either not enter and run unless I am medically able and properly trained. I agree to
abide by any decisions of a race official relative to me safely completing the event. Having
read this waiver, and in consideration for you accepting my entry, I, for myself and anyone
entitled to act on my behalf, waive and release the Geib Funeral Homes & Crematories|
Dover & New Philadelphia, Ohio, their directors, organizers, and all sponsors and
representatives and successors from all claims of liability of any kind arising out of my
participation in the event. I hereby grant full permission to any or all of the foregoing to use
any photographs, video tapes, motion pictures, recordings, or any other record of this event
for any legitimate purpose. All race entries are non-refundable. We reserve the right to reject
entries.

I have read and agree to the terms of the liability waiver.
(select one)

If entrant is under 18 years of age, I declare I am their legal
guardian.

2013Letter.pdf

sponser.pdf

walk2013Flyer.pdf

Link to Akron Childrens Donor Site

Download Entry Form

Entry Form