WALk A miLe in Her SHoeS®: - Northeast Health

In spirit of the phrase,
“
you can’t really understand another person’s
experience until you’ve walked a mile in their shoes, ”
we are asking men to seek sponsorships in exchange for agreeing
to walk one mile in women’s shoes — demonstrating a willingness
to be a courageous partner with women in making the world a safer place.
SPONSORS
(as of 4/3/13)
PLATFORM
Proceeds benefit the Sexual
Assault and Crime Victim Assistance
Program for Rensselaer County.
Services, free and confidential, include:
• 24-hour crisis hotline
• Free short-term counseling
• Legal and medical advocacy
and accompaniments
• Prevention and professional
education programs
• Senior Crime Victim Program
• Crime Victims with Disabilities Program
• Sexual Assault Forensic Nurse
Examiner Program
Walk a mile
in her shoes ® :
The International Men’s March
to Stop Rape, Sexual Assault
& Gender Violence
wedge
PUMP
Kaleel Jamison
Consulting Group
Mary Jane
Emergency Medicine Physicians
at Samaritan Hospital
First Niagara Bank
Peep-toe
Capital Bank
Martin, Harding & Mazzotti
Truly Rhe’s
BBL Construction
Citizens Bank
CDPHP
Hart Alarm Systems, Inc.
Photography by:
Live music by:
Hilton Garden Inn Troy
Noble Gas Solutions
Wilson Elser
MEDIA SPONSORS
(as of 3/5/13)
Our Mission
The Sexual Assault and Crime Victims Assistance
Program for Rensselaer County is committed to
reducing the trauma of sexual assault, crime, and
violence, as well as providing community education
for its prevention. We are dedicated to creating a
supportive, caring environment for victims/survivors
and their families to enhance the healing process.
Samaritan Hospital
Lally Pavilion
April 27, 2013

WALK A MILE IN HER SHOES ®
Saturday, April 27, 2013
Samaritan Hospital, Lally Pavilion in Troy, NY
Prizes for: Top Team Fundraisers & Top Individual Fundraiser
Check-in/In-person Registration — 10 am
Walk — 11 am
Emcee: Nick Johnston,
Morning Meteorologist, CBS6
Awards Presentation and Reception to follow
REGISTRATION FORM
Name:______________________________________
Address:____________________________________
City:______________ State:______ Zip:_________
Phone:_______________ Email:________________
Team Leader (if any):_________________________
Team Name:________________________________
My company has a matching gift program.
Name of company:________________________
My $10 pre-registration fee is enclosed.
(On or after April 1, registration fee is $20)
Please make checks out to
“Sexual Assault & Crime Victims”
Credit card: Visa MC
American Express
Acct #:_____________________________________
Exp:_________ /____________
Name as listed on credit card:
___________________________________________
Signature:___________________________________
Co-Chairs:
James Reed, MD, President & CEO,
St. Peter’s Health Partners
Joseph R. Nicolla, President,
Columbia Development Companies
I don’t have my own heels; I wear
a men’s size________ .
*Registration after April 1 does not guarantee heels.
I will bring my own heels.
I am not brave enough to wear heels
and will march in my own shoes.
My T-Shirt Size: M L XL XXL (circle one)
The first 500 registrants will receive an official
Walk a Mile t-shirt.
You may also register online:
www.NortheastHealth.com/Walk_A_Mile
Walk a Mile Waiver
In consideration of my entry in the Walk a Mile event, I, for
myself, my heirs, my executors and administrators, waive and
release any and all rights and claims for damages I have or may
have hereafter against the organizers of the event, its participants,
its employees, all sponsors and their representatives and
all claims of damages, demands, actions whatsoever in any
manner, as a result of my participation in this event, including
travel to and from event. I attest and verify that I am physically
fit and have successfully trained for completion of this event
and I have not been advised otherwise by a qualified medical
person. Further, I agree to any and all of the forgoing to use
my name and likeness in any broadcast, telecast, video or print
media of this event without compensation.
Signature:___________________________________________
Date:______________________________
All entrants (parents/guardians if under 18) must sign.
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Mail registration form and entry fee to:
(Please do not send cash)
Sexual Assault & Crime Victims
Assistance Program
c/o Northeast Health Foundation
2224 Burdett Avenue
Troy, NY 12180
SPONSORSHIP FORM
Name:______________________________________________________
Team Name (if applicable):_____________________________________
Pledge
name Address Amount
You may also sponsor a walker online: www.NortheastHealth.com/Walk_A_Mile
For more information, contact Lisa Smith at: (518) 271-3639 or SmithLisa@nehealth.com
Bring sponsor form and funds raised
to the event or mail a check to
(Please do not send cash)
Sexual Assault & Crime Victims Assistance Program
c/o Northeast Health Foundation
2224 Burdett Avenue
Troy, NY 12180