19THANNUAL

and Butterfly Release

To benefit the Cancer Patient Help Fund and the Cancer Screening & Outreach Fund

Sunday, Sept. 21, 201411 a.m. to 2 p.m.

Indian Rock Elementary SchoolYork, PA

Walk or bike along the scenicHeritage Rail Trail County Park

Rain or Shine

Keep the cycling & walking going!

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19THANNUAL

and Butterfly Release

GiftForm

Special thanks to our sponsors:Diamond Sponsors:

Platinum Sponsors:

You can also register online at www.wellspan.org/bikehike

Participant

Address

City State Zip

Phone Number Email

Supporter’s Name Supporter’s Address, City, State, Zip Amount Collected

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Total

• White Rose Interiors • Anstadt Communications• Apple Hill Surgical Center • Glatfelter Insurance Group• Penn Waste • Dr. Larry Oxenberg

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What, where and when? Date: Sunday, Sept. 21, 2014

Time: 11 a.m. to 2 p.m. (You may register any time after 11 a.m. and before 1 p.m.)

11 a.m. Butterfly Release

Start: Indian Rock Elementary School 1500 Indian Rock Dam Road York, PA 17403

Transportation will not be provided back to the beginning of the ride. You can walk or ride up to 10 miles. All participants can select their own level/distance and bike or walk at their own pace.

Visit us on the web at www.wellspan.org/bikehike

About the Bike HikeBy participating in the 19th Annual Bike Hike,

you can combine recreation and exercise with the satisfaction of helping area residents in need. One hundred percent of proceeds benefit the Cancer Patient Help Fund and the Cancer Screening & Outreach Fund.

Butterfly ReleaseYou, a group or family, may purchase a live

butterfly to release in honor or in memory of a loved one. We will hold a release ceremony at 11 a.m. If you are unable to be present to release your butterfly, a volunteer will release the butterfly for you. The cost is $25 per butterfly. The deadline to request a butterfly is Sept. 7th. You do not have to be registered for the Bike Hike to participate in the Butterfly Release.

Event T-Shirts –All individual participants will receive an event t-shirt.

How do I participate?1. Collect monetary donations from your friends,

family members, neighbors, co-workers and others who would like to support your participation in the event on behalf of the Cancer Patient Help Fund.

2. Record their names and contributions on the Gift Form on the reverse side of this brochure.

3. Bring the Gift Form and your contributions to the Bike Hike registration table on the day of the event.

Team and Individual ChallengesThe team that raises the most funds and the

individual participant who raises the most funds will be awarded a trophy at a luncheon after the event.

Event managed by York Health Foundation.

About the MissionFor patients and families who battle cancer, there

are not only emotional and physical impacts, but there is also an overwhelming – and often unexpected – financial impact. Even for patients with insurance, the cost of cancer care can deplete a family’s resources and strain their ability to cope at an already stressful time.

The Cancer Patient Help Fund was created to lessen this impact on individuals and families, by making funds available for everyday expenses such as rent, utilities, groceries and transportation. By easing this burden, the Fund allows cancer patients and their families to focus their energies on the important task of healing.

The Cancer Screening and Outreach Fund was established to assist us in our efforts to increase early diagnosis and treatment of cancer in York and Adams counties by providing funding for cancer screening tests for eligible individuals. It also allows us to provide more educational and outreach services to our local communities.

ReleaseImportant: All who participate must sign the

attached registration form agreeing to this release. A parent or guardian must sign for participants under the age of 18. All participants under the age of 13 must be accompanied by an adult (18 or older). Please be sure to return the attached registration form with all required signatures.

I (we) hereby agree to absolve and hold harmless the York Cancer Center, corporate sponsors, cooperating organizations and any other parties associated with this Bike Hike event in any way singly or collectively from and against blame and liability for any injury, misadventure, harm, loss, inconvenience or damage suffered or sustained as a result of participation in this event. I (we) also hereby consent to and permit emergency treatment in case of injury or illness. I (we) understand that a helmet must be worn by all cyclists participating in this event.

19THANNUAL

and Butterfly Release

Registration Form

Complete and return this form with your non-refundable registration fee to the address below.Team registration forms must include each participant’s name in the group.

For printed forms, please mail to:

York Health Foundation50 North Duke St.York, PA 17401

For information, please call 851-3029

All participants receive a t-shirt.Make checks payable to Cancer Patient Help Fund

____ Individual Registration $ 20 (age 13 and up)

(children 12 and under FREE)

____ Butterfly Release: .($25 each) $

____ In honor of (please print)

____ In memory of (please print)

Participant or Team Leader (please print)You can register online at www.wellspan.org/bikehike

Signature of Participant, Team Leader, or Parent/Guardian

Signature of Team Member or Team Members (please print) Parent/Guardian

Attach additional form(s) if neededMy signature above indicates that I (we) have read and fully understandthe information contained in the release on the York Cancer Center’s Bike Hike brochure. I also understand that my signature or the signatureof my parent/guardian is required to participate.

Participant or Team Leader

Address

City State Zip

Phone

Email Address

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