2015 NAMIWalks Registration Form

ABOUT NAMI
NAMI, the National Alliance on Mental Illness,
is the nation’s largest grassroots mental health
organization dedicated to building better
lives for the millions of Americans affected by
mental illness. NAMI advocates for access to
services, treatment, supports and research.
NAMI is steadfast in its commitment to raising
awareness and building a community of
hope for all of those in need.
Located in Cincinnati, Ohio, NAMI of
Southwest Ohio is dedicated to raising
awareness and providing essential education,
advocacy, and support group programs for
people living with mental illness and their
loved ones. NAMI of Southwest Ohio
addresses the mental illness needs of our
community, replaces stigma with
understanding and helps thousands of
families and individuals each year. NAMI of
Southwest Ohio is a 501(c)(3) grassroots
mental health organization.
NAMI of Southwest Ohio 2015
NAMIWalks to End Mental Illness
Date: Saturday, May 9, 2015
Distance: 5K
Check-in: 9:00 a.m.
Start Time: 10:00 a.m
For more information about this event, please
contact:
Heather Turner
[email protected]
(513) 351-3500
Registration
Form
Walk Information
Registration Form
2015
2015
All walkers must register for the walk. There is no
registration fee for walking, but we do ask walkers to
consider fundraising.
Yes! I would like to register to walk with 2015 NAMIWalks To End Mental
Illness!
Name:
Address:
City, State, Zip:
Date: May 9, 2015
Phone:
Adult:
Email:
Yes/No
Location: Sawyer Point
NAMI Affiliate/State:
Check-in time: 9 a.m.
Team Name:
Start time: 10 a.m.
Total distance: 5 Kilometers (optional shorter route)
Free ample parking
Refreshments, music and fun!
For more information, please contact:
NAMI of Southwest Ohio
4790 Red Bank Expy., Suite 218
Cincinnati, OH 45227
(513) 351-3500
Child (Under 18): Yes/No
Team Captain:
Team Captains: To ensure accurate credit to your team’s total, we encourage you
to fill in the team name and team captain lines on all registration forms and walker
donor forms before you distribute them to your walkers. Thank you!
Individual Walker
Walker on a team
Team Captain
Walk day volunteer. Please call me.
I cannot attend the walk. I have enclosed my donation in the amount of
$_________________ to support NAMI.
Please send __________________ extra brochures
Each participant must sign below.
I hereby waive all claims against NAMI, sponsors, or any personnel for any injury that
I might suffer in this event. I attest that I am physically fit and prepared for this event.
I grant full permission for organizers to use photographs of me and quotations from
me in legitimate accounts and promotions of this event.
_______ Yes, I accept the waiver.
[email protected]
Signature:________________________________________________________________
www.namiswoh.org
Parent or Guardian:______________________________________________________
(if walker is under 18 years of age)
Please turn in this Walker Registration Form to your Team Captain or mail to: NAMI of
Southwest Ohio, 4790 Red Bank Expy. Suite 218, Cincinnati, OH 45227.
`