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Date of Walk - Huntington's Disease Society of America

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Team hope: providing help for<br />

today, hope for tomorrow<br />

When you register for a Team Hope walk, the money you raise<br />

supports HDSA’s fight to improve the lives <strong>of</strong> people affected by<br />

Huntington’s disease and their families.<br />

Team Hope walks take place in more than 80 cities across the U.S.<br />

Since its inception in 2007, Team Hope has raised more than $2<br />

million due to the tireless efforts and ongoing support <strong>of</strong> walkers<br />

like you!<br />

Team Hope: In Your Community<br />

• Encourage friends, family, co-workers and community members<br />

to participate in Team Hope.<br />

• Create an online Firstgiving fundraising page.<br />

• Join a Team Hope walk committee.<br />

• Form a company team.<br />

• Recruit businesses to sponsor the Team Hope walk in your<br />

community.<br />

• Send out a letter campaign to request donations.<br />

• Double your dollars with company matching gifts.<br />

Team Hope: Raise Big, Win Big<br />

• Top National Fundraiser Grand Prize: 5 night staty at JW Marriot<br />

or Los Suenos Marriot in Costa Rica accomodations and roundtrip<br />

airfare for 2.<br />

• Overall Second and Third National Fundraisers: Round Trip flight<br />

anywhere in the continental U.S.<br />

Some restrictions apply. See www.hdsa.org/teamhope for details.<br />

Team Hope:<br />

National Recognition<br />

• The Overall top 5 individual fundraisers and the top 5 teams<br />

will be recognized locally and nationally on HDSA web sites<br />

and newsletters.<br />

Arizona<br />

Arkansas<br />

California<br />

Colorado<br />

Connecticut<br />

Delaware<br />

Florida<br />

Georgia<br />

Iowa<br />

Illinois<br />

Indiana<br />

Louisiana<br />

Maine<br />

Maryland<br />

Massachusetts<br />

Michigan<br />

Minnesota<br />

Missouri<br />

Nebraska<br />

New Hampshire<br />

New Jersey<br />

New Mexico<br />

New York<br />

North Carolina<br />

North Dakota<br />

Ohio<br />

Oklahoma<br />

Oregon<br />

Pennsylvania<br />

Rhode Island<br />

South Dakota<br />

Tennessee<br />

Texas<br />

Virginia<br />

Washington<br />

Wisconsin<br />

All proceeds raised from<br />

Team Hope support the<br />

Huntington’s <strong>Disease</strong> <strong>Society</strong> <strong>of</strong><br />

<strong>America</strong>’s efforts to provide help<br />

for today, hope for tomorrow for<br />

families affected by HD.<br />

(Tear <strong>of</strong>f and mail this form)<br />

REGISTRATION FORM<br />

<strong>Walk</strong> Location:<br />

Fundraising Goal:<br />

Name:<br />

Home Address:<br />

City/State/Zip:<br />

Work Phone:<br />

Home Phone:<br />

Email:<br />

Company/Organization:<br />

Team Name/Team Captain:<br />

q Please send me information on forming a team.<br />

q In addition to walking, I’m interested in volunteering.<br />

q I wish to decline my prize.<br />

q I am unable to walk, but will make a donation <strong>of</strong><br />

$_______________<br />

q My company has a matching gift program.<br />

Please make all checks payable to HDSA.<br />

T-Shirt Size: q S q M q L q XL q XXL<br />

q I wish to decline a shirt.<br />

Registration deadline: 2 weeks prior to the walk<br />

For walk questions please call 877-WALK4HD<br />

or visit www.hdsa.org/teamhope<br />

Each participant must read & sign below<br />

I, the undersigned, agree to indemnify and hold harmless the Huntington’s <strong>Disease</strong><br />

<strong>Society</strong> <strong>of</strong> <strong>America</strong> (HDSA) from all cost, expense and liability arising out <strong>of</strong> my or<br />

my child’s participation in this event to benefit the HDSA. I do hereby waive all claims<br />

for damage or loss to me or my child’s person or property which may be caused<br />

by any act or failure to act, by HDSA, its <strong>of</strong>ficers, agents, volunteers or employees<br />

arising directly or indirectly from my or my child’s participation in this event; and I<br />

hereby assume liability for any loss, damage or other liability from such event.<br />

I hereby give permission to the HDSA and their respective designees to take, use,<br />

reproduce and publish any and all photographs and videotapes which may be taken<br />

<strong>of</strong> me and/or my child immediately before, during or immediately after this event<br />

without compensation to me. I understand and agree that all such photographs and<br />

videotapes will be the sole and complete property <strong>of</strong> the HDSA.<br />

Signature<br />

<strong>Date</strong><br />

Must be signed by parent or legal guardian if participant is under 18

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