Walk-a-Thon Brochure 2010

Walk-a-Thon Brochure 2010

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  More than 57,000Americans will die from colon cancer thisyear. But numerous local and national groups are working year. But numerous local and national groups are working hard to save lives by supporting colorectal cancer awareness, prevention, treatment, andin their battle at prevention, treatment, and research. Join research. TO APPLY ONLINE Board of Directors Join in their battle at on March 6th, 2010. This 3-mile walk around Tom Bass Park can help save lives! No matter what distance youyou cover, you’llhelping to win win the race what distance cover, you’ll be be helping to the race against colon cancer. against colon cancer. www.HopeThroughGrace.org (credit card payments only via Secure Grace L. Butler, Ph.D. HTG Founder & President Elaine Pearson, M.Ed., MBA LCDR, USN (Ret) HTG Secretary/Treasurer The Houston Professor Emeritus RACE INFORMATION PayPal System) University of Houston Everett L. Sandles, M.D. HTG Historian Colon Cancer Yvette Chargois TO APPLY BY FAX Saturday, March 6, 2010 Tom Bass Park III, Area Drive Complete this form with your credit card The Houston Defender Olethia E. Chisolm, M.D. TX Children’s Pediatric Associates Challenge® information, and fax it to HTG at HTG Events Coordinator Victor Simms, M.D. Pavilion 5 HTG Education Director Promoting Color Cancer Awareness, 713-668-6040. Kelsey-Seybold Clinic 15108 Cullen Blvd. Kelsey-Seybold Clinic Prevention and Advocacy Houston, TX 77047 Brian Herrington Registration: 8 a.m. – 9 am. Fax and online registration closes on March Harrington, Carbone & Allison, Margo Hilliard, MD, MPH Walk begins at 9 a.m. 3rd, 2010 LLP Senior Vice President of Saturday, March 6th, 2010 Community Services Aretha Johnson, R.N. Harris County Hospital 8 am HOW TO REGISTER TO APPLY BY MAIL District HTG Vice President Liberty Island Care Homes Tom Bass Park III You can register online at Complete this form and mail this entry Pavilion 5 www.HopeThroughGrace.org with your payment (check or credit Kenneth Levingston card information) to: Sr. Pastor 15108 Cullen Blvd. or by calling 713 – 668 - 4673 (HOPE) Registration closes March 3rd, 2010 Jones Memorial United Methodist Church Houston, TX 77047 No money can be transferred at the park. Hope Through Grace, Inc. 4660 Beechnut St., Ste. 102 Sponsored By DAY OF WALK Houston, TX 77096 Entrants are required to sign in between No money can be exchanged at the park. 8a.m. and 9a.m. the morning of the walk. You No exceptions. must have pre-registered either online or by sending in this registration form prior to FOR MORE INFORMATION March 3rd, 2010. About the Walk: POST-RACE Please call Amy Brown Please join us after the walk for the awards 713-668-4673 (HOPE) ceremony where we will acknowledge colon cancer survivors, those special angels About Hope Through Grace: who we have lost and others who are "Champions the Cause." www.HopeThroughGrace.org Take the Challenge with Hope Through Grace by joining our 5th Annual Walk-A-Thon!
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  P L ED G E FORM R E G I S T R ATION FORM FOR MORE INFORMATION TAKE THE CHALLENGE! Please ll out the following information below to register by MAIL OR FAX only. Call You can make a di erence in the ght against colorectal cancer 718-668-4673 by helping us raise funds for this cause. All funds raised directly Visit support Hope Through Grace’s mission and initiatives. This mission www.HopeThroughGrace.org includes supporting e orts to provide colonoscopies for the uninsured First Name and underinsured. Las t Name WAIVER: To get started, go to www.hopethroughgrace.org and under the EVENTS Emergency Contact Name and Tel. tab you can nd more information for the Colon Cancer Challenge, and (required) Upon registration on March 6th, 2010 you will be register yourself or a team. You also can use the form below to keep track Address required to sign the following waiver: of your pledges. City S tate (or country if not USA) I know that participating in this HTG event is a potentially Please have your pledges prepay with checks made payable to: Zip Hope Through Grace, Inc. All contributions are tax deductible. hazardous activity. I agree not to enter and participate E-mail Address unless I am medically able. I agree to abide by any On March 6th bring this form and your pledge’s donations to the Team name (optional) decision of an event o cial relative to my ability to Hope Through Grace envisions a society in which registration tent located at : Tom Bass Park III safely complete the event. I am voluntarily entering and the incidence and mortality rates of colorectal cancer are ENTRY FEES Pavilion 5 assume all risks associated with participating in the diminished and ultimately eradicated. HTG participants 15108 Cullen Blvd., Houston, TX adopt life changing attitudes, beliefs and behaviors that 77047 event, including, but not limited to, falls, contact with promote wellness and healthy living. To ful ll this vision,  $25 per person other participants, spectators or others, the e ect of the we invite you to join the challenge to stamp out colorectal cancer. Registration is from 8 a.m. – 9 am. weather, including heat and/or humidity, tra c and  $20 for students (with valid student ID) the conditions of the course, all such risks being known FACTS YOU SHOULD KNOW Your Name and appreciated by me. I am also agreeing to the P A YMENT INFORMATION Team Name Photo/Video Release which grants Hope Through Grace  Women and men are at equal risk for developing  Enclosed is my check made payable to Hope Through Grace. the permission to photograph myself and any colorectal cancer. Address persons that I bring onto the property. City S tate Zip  Please charge to my: Visa MasterCard American Express (circle one) _$25 _$20  Colorectal cancer is the #1 non-tobacco-related cancer Having read this Waiver and knowing these facts, and in Phone E-mail Addres s killer of women AND men in the United States. Faxes and credit card payments are not accepted day of event. No exceptions. consideration of your acceptance of this application, I, CREDIT CARD # for myself and anyone entitled to act on my behalf,  This year in the United States nearly 150,000 people will Pledge Name waive and release Hope Through Grace Inc., Tom Bass be diagnosed with colon cancer and 57,000 deaths will Exp. Date Park, the City of Houston and its agencies and result. Pledge E-mail Pledge $ CARDHOLDER SIGNATURE departments, its a liates, o cers, directors, employees Name as it appears on my card and agents, and all sponsors, and their representatives  African Americans have the highest incidence and death Pledge Name and successors, from present and future claims rates from colorectal cancer in the United States. and liabilities of any kind, known or unknown, arising Pledge E-mail Pledge $ out of my participation in this event or related activities,  Colorectal cancer screening saves lives. even though such claim or liability may arise out of Pledge Name negligence or fault on the part of any of the foregoing persons or entities. OUR CORE BELIEF Pledge E-mail Pledge $ I grant permission to the foregoing persons and entities “No matter what one’s situation in life, there is Pledge Name to use or authorize others to use any photographs, always a good hope through the grace of God.” motion pictures, recordings, or any other record of my Pledge E-mail Pledge $ participation in this event or related activities for any II Thessalonians 2:16-17 legitimate purpose without remuneration. Pledge Name Pledge E-mail Pledge $ Total $