2016 Law Enforcement Torch Run

for Special Olympics Illinois Kickoff Conference

Friday, Feb. 12, 2016

Doubletree Hotel & Conference Center, 10 Brickyard Dr., Bloomington

Questions?

Chief Eric Smith Tom Reasoner Sandy Nash

Torch Run Director Torch Run Asst. Director Special Olympics Illinois

217-306-5753 NEMRT 800-394-0562

630-896-8860 x114 309-888-2570 (fax)

2016 Torch Run Kickoff Registration Form

Simply Click Here to Complete Your Registration & Request Your Merchandise Online.

To Register or Order merchandise Offline Complete This Form

Name: ______Department: ______

Address: ______City: ______Zip: ______

Phone (Work):______Fax: ______

E-Mail: ______Leg #:______

The following people from my department will be attending the conference with me:

*Confirmation of your attendance will be sent via e-mail (no limit on # of attendees – make copies as needed)

1.______E-Mail:______

2.______E-Mail:______

3.______E-Mail:______

Total Attending Conference: ______Our Agency Will NOT Be Attending: ______

To guarantee that your order will be available in full at the Kickoff, Please mail, fax (309-888-2570), E-mail or submit this form online by Monday, Jan. 18 to Sandy Nash. Orders placed after this date may not be completed in full at the Kickoff and would be mailed at a later date.

PLEASE NOTE: You may still register for the Conference after the above date (Jan. 18).

Law Enforcement Torch Run Merchandise Order Form

Departments can order Torch Run items to sell in exchange for donations to Special Olympics Illinois (no cash required up front). Please be conservative on your initial order. These items come with a cost to our LETR program and will be tracked to help avoid an excess inventory at the end of the year. You can request additional items throughout the year.

Our department would like to order the following items to sell for the 2016 Torch Run Campaign:

(We require a minimum donation of $15 per T-shirt, $15 per hat and $5 per pin!)

T-Shirts Qty.

Small: ______

Medium: ______

Large: ______

X-Large: ______

2XL: ______

3XL: ______

Hats: ______

Pins: ______

Harley Tickets*: ______

(*Sold for $10 each)

Harley Posters: Circle one: 5 10 15

TR Brochures: Circle one: 25 50 100

TR Posters: Circle one: 5 15 25