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&
 
are proud to present
A Race To Remember
7 
th 
Annual Grand Slalom Challenge 
Snowboarders are welcome.
Sunday, January, 10, 2010
Registration:
8am – 10am
Race begins:
10:30am
Location:
Belleayre MountainSki ResortHighmount, NY
 
To register contact
Karen Skelton
:1-800-872-0994 Ext. 107,Karen.Skelton@alz.org orvisit our website:www.alz.org/hudsonvalley 
Pre-registration ends at 5:00pm onTuesday, January 6, 2009
 
HELPING
local families served by the
Alzheimer’s Association
Hudson Valley/Rockland/Westchester, NY Chapter
Non-refundable Ticket
(valued at $58)
 $25.00
per person includingan All Day Lift Ticket and Race Entry
ORNon-refundable Ticket
(valued at $88)
 $40.00 per person including
•
 
All Day Lift Ticket
•
 
Race Entry
•
 
Hot Breakfast Buffet
•
 
Champion T-Shirt
•
 
1 Free Raffle Ticket
(limited to the first 200 people)
 
 
 
are proud to present
A Race To Remember
7
th
Annual Grand Slalom Challenge
 
RACE INFO:
 
Sunday, January 10, 2010, 10:30 a.m. Race check-in will be from 8:00 a.m. to 10:00 a.m. on the dayof the race at the Upper Lodge at Belleayre Mountain. The race will be a grand slalom and challengers will be scoredon the best time of two runs.BEGINNERS WELCOME
.
 Please join us for the special “Alzheimer's Day” 
 Breakfast
 – 
8AM 
CATEGORIES
:
Medals will be awarded to the first, second and third place finishers in all categories.
ALL RACERS
 
MUST WEAR HELMETS
 
Girls6-8 years of ageBoys6-8 years of ageGirls9-12 years of ageBoys9-12years of ageGirls13-18 years of ageBoys13-18 years of ageWomen19-34 years of ageMen19-34 years of ageWomen35-49 years of ageMen35-49 years of ageWomen50 years of age +Men50 years of age +
HOW TO REGISTER:
1.
 
Fill out the reservation form, listing all members of your group
2.
 
Have each participant complete the attached Waiver
 
3.
 
Mail the completed Reservation/Waivers Form
by 5pm Tuesday, January 6
th
2010
with thenonrefundable pre-registration contributions of $25.00 per person/Race Entry to:
Alzheimer’s Association
 2 Jefferson Plaza, Suite 103Poughkeepsie, New York 12601-4027
~
FAX (845) 471-8960
 All checks should be made out to
Al
zheimer’s Association
 
Reservations using major credit cards (Visa, Master Card, American Express & Discover), can beaccepted over the phone by calling 1 (800) 872-0994The $25 registration fee is fully tax-deductible
PRE-REGISTERED RACERS DO NOT NEED TO BUY A LIFT TICKET
: Belleayre Mountain willprovide lift tickets at check-in on the day of the event to ALL REGISTERED PARTICIPANTS (Upper Lodge,Belleayre Mountain Ski Resort, between 8:00 am
 – 
10:00 am on Sunday, January 10, 2010). *Event participants who
do not 
pre-register by 5:00 pm on Tuesday, January 5, 2010 must purchase a full price lift ticket in addition to the $25Race Entry Fee.
 
All proceeds from the $25.00 per person Race Entry Fee/Donation
will benefit the families served by the Alzheimer’s Association,
 Hudson Valley/Rockland/Westchester, NY Chapter.
 
 
A Race To Remember
Reservation/Waiver Form
Name: ______________________________________________________ Date of Birth
 
(REQUIRD)
: _________________Address: _____________________________________________________________________________________________City: _____________________________________________ State: _______________________ Zip: _______________Telephone: __________________________________________________________________________________________E-Mail: _____________________________________________________________________________________________
TOTAL # persons in your group
(ALL info REQUIRED for each)
:
_______________________________
Name DOB Age
1._____________________________ __________ ________2._____________________________ __________ ________3._____________________________ __________ ________4._____________________________ __________ ________5._____________________________ __________ ________6._____________________________ __________ ________7._____________________________ __________ ________8._____________________________ __________ ________9._____________________________ __________ ________10.____________________________ __________ ________
 Each participant in this event must complete & sign this waiver
and return it to the
 Alzheimer’s Association, Hudson
Valley/Rockland/Westchester, NY Chapter 
 prior to the start of the event
 , to qualify for the lift ticket provided by Belleayre Mountain during registration/check-in.
AMOUNT DUE: $_________ ($25 each IF received on/before 5pm 1/6/10 ~ $68 each if received after 5pm 1/5/10)$_________ ($40 package IF received on/before 5pm 1/6/10
 
____ Unfortunately, I will not be able to attend, but I have enclosed a $__________ donation to help local Alzheimer families and
to help MOVE us closer to a world without Alzheimer’s disease!
 ____ I have enclosed a check for $_________, made pay
able to Alzheimer’s Association
- Chk#:________ Chk Date:__________
 ___ I authorize the Alzheimer’
s Association to charge $___________, to my credit card below:
AmEx
MasterCard
Visa
Discover CARD #__________________________________Exp Date: __________________________ CVV# (3 or 4 digit verification code): _______________Authorizing Signature: ______________________________________________________________________
 
*Payment Information: (all payments are nonrefundable)*
Release:
I understand that skiing and snowboarding are sports with inherent risks and that by racing (or otherwise using the day-long lift ticket associated with this event), I am increasing my (my
child’s) risk. I do hereby release and discharge the Alzheimer’s Assoc
iation, Clear Channel, and Belleayre Mountain Ski Center, its Ski School, and all other sponsors and their representatives and
successors from all claims of damages, actions and causes of action arising out of my (my child’s) participation in this race
&/or use of the day-long lift ticket associated with this event. I certify that Iam (my child is) physically fit and qualified to participate in this race & or to use the lift ticket associated with this event.I further understand that I (my child) might be photographed while participating in this event. I hereby authorize the reproduction of any pictures that might be taken of me (my child), whether they arestill or video. I hereby waive all right to compensation for the use of any picture taken, regardless of type of use or exposure chosen. I place no restriction of the use of any photographic likeness
and agree to hold harmless all individual photographers assigned as well as discharge the Alzheimer’s Association, Clear Chan
nel,and Belleayre Mountain Ski Center, its Ski School, and all other sponsors and their representatives and successors.
Applicant Signature:
Girls6-8 years of ageBoys6-8 years of ageGirls9-12 years of ageBoys9-12 years of ageGirls13-18 years of ageBoys13-18 years of ageWomen19-34 years of ageMen19-34 years of ageWomen35-49 years of ageMen35-49 years of ageWomen50 years of age +Men50 years of age +
 
ALL RACERS MUST WEAR
 
HELMETS
 
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