Oct 25, 2014 - Pinehurst Neuropsychology. Miller-Boles. Funeral Home. THE ENRICHMENT CENTER. OF LEE COUNTY. Certified Ce
Registration Form My goal is to raise $
to help NC families.
Name Address City State Zip Phone E-Mail Employer/School My employer has a matching gift program I will be requesting funds from. Yes No team captain an individual I am walking in honor or memory of
Lead Sponsor:
Gold Sponsors: THE ENRICHMENT CENTER OF LEE COUNTY Certified Center of Excellence
I will be walking at (site): I will be walking as
Thank you to our 2014 Walk Sponsors!
team member
Silver Sponsors:
Sanford/ Lee County Alzheimer’s Walk The Enrichment Center Walking Trail 1615 S. Third Street Sanford, NC
If you are on team, please complete the following: Team Name Representing (name of organization if applicable)
Bronze Sponsors:
Team Captain’s Name
Miller-Boles Funeral Home
Assumption of Risk, Release & Permission
In consideration of being allowed to participate in the Alzheimers North Carolina Walk, I hereby expressly assume all risks of personal injury, death, or property loss arising in any way out of my participation. I represent that I am physically fit and able to participate in this event. I hereby release and agree not to sue AlzNC, its respective directors, volunteers, employees, sponsors and agents, from or in connection with any and all liability and claims arising out of my participation in this event. I grant full permission to the organizers of this event to use and publish my name and image as a participant in photographs, video, or other recordings.
For more information, call or email: Pinehurst Neuropsychology
Friends:
Name Date
(parent or guardian’s signature if walker is under 18 years of age)
Return your form and/or donations to your walk committee or send to AlzNC, 1305 Navaho Drive, Suite 101, Raleigh, NC 27609.
REGISTER ONLINE: www.alznc.org/walks
Saturday, October 25, 2014 Registration: 12:00 Noon Walk Begins: 1:00 p.m. Judi Womack (919) 776-0501 ext. 2230 jwomack@ leecountync.gov
Meg Moss (919) 718-5417 meg.moss@ communitycompanies.com
Online Donations: www.alznc.org/walks Thank you to our sponsors, walkers, in-kind donors and wonderful volunteers. We couldn’t do what we do without you!
100% of your dontions stay in North Carolina to support families affected by Alzheimer’s disease & other dementias.
Contribution Form Name Address City State Zip Phone E-Mail My fundraising goal:
Sponsor’s Name
Donation Amt.
The Day’s Events
Alzheimers North Carolina has been dedicated for over 30 years to providing education, support, and services to individuals with dementia, their families, health care professionals and the general public. AlzNC is a 501(c)3 nonprofit organization. Tax ID #56-1501117.
Learn how we can help you: www.alznc.org 1-800-228-8738
[email protected]
12:00 Noon: Walk Registration 12:45 p.m.: Opening Ceremony 1:00 p.m.: Walk
Entertainment
Walk with Us!
Together as a community, we can make a difference in the fight against Alzheimer’s disease & other dementias. By raising awareness and funds for the walk, you’re supporting families in your community.
How You can Help
1. Register to walk with family, friends, or co-workers. You can sign up online or use the form on this brochure. 2. Spread the word! Share information about the walk in your community. Contact your local walk chair about flyers or information you can pass out.
Food Sponsor Displays Pet Bandanas Available Home of the
3. Be creative in raising funds for yourself or your team! Have a casual dress day at work, with employees donating to wear jeans. Hold a bake sale. Use social media. There are dozens of ways to fundraise and have fun!
Matching gifts could double your money!
Subtotal Matching Gift Total Enclosed
Please make checks payable to AlzNC.
Raise $50 or more and receive a free t-shirt on the day of the walk!
Honor a loved one by attaching a photo to the Alzheimer’s wall - a temporary monument that pays tribute to those affected by the disease and those who have passed on.
