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R U N 2 0 1 2Because Mental Health Matters
PLEDGE SHEETWe encourage all race participants to raise pledges in lieu of their registration fees. This can be done either online using the Sponsor an Athlete website, or by downloading a brochure and collecting pledges in person. After you register for the event, your entry fee will be refunded if you raise the following amounts:
Pledges can be dropped off at Race Kit Pickup or on race day prior to the race. Then, once the pledges are submitted, a refund will be issued by mail, upon application.
• $160 for the half marathon• $110 for the 10 km run/walk• $50 for the 5 km run/walk
Make cheques payable to IMAGINEGo online and sponsor a runner at www.runningroom.com
Tax receipt given with the minimum donation of $10
NAME
CITY
PLEDGE AMOUNT
CREDIT CARD NO.
TAX RECEIPT PAYMENT METHOD
POSTAL CODE PHONE NUMBER
EXPIRY DATE
ADDRESS
YES CASH CHEQUE VISA MASTERCARDNO1
NAME
CITY
PLEDGE AMOUNT
CREDIT CARD NO.
TAX RECEIPT PAYMENT METHOD
POSTAL CODE PHONE NUMBER
EXPIRY DATE
ADDRESS
YES CASH CHEQUE VISA MASTERCARDNO5
NAME
CITY
PLEDGE AMOUNT
CREDIT CARD NO.
TAX RECEIPT PAYMENT METHOD
POSTAL CODE PHONE NUMBER
EXPIRY DATE
ADDRESS
YES CASH CHEQUE VISA MASTERCARDNO4
NAME
CITY
PLEDGE AMOUNT
CREDIT CARD NO.
TAX RECEIPT PAYMENT METHOD
POSTAL CODE PHONE NUMBER
EXPIRY DATE
ADDRESS
YES CASH CHEQUE VISA MASTERCARDNO3
NAME
CITY
PLEDGE AMOUNT
CREDIT CARD NO.
TAX RECEIPT PAYMENT METHOD
POSTAL CODE PHONE NUMBER
EXPIRY DATE
ADDRESS
YES CASH CHEQUE VISA MASTERCARDNO2
R U N 2 0 1 2Because Mental Health Matters
• Half Marathon • 10K Run/Walk • 5K Run/Walk •• Half Marathon • 10K Run/Walk • 5K Run/Walk •
• Family Fun Day • Bands on Route/Park • Balloonist • Petting Zoo •• $4 BBQ by Crystal Springs • Party Bouncers • Children’s Games •
• Family Fun Day • Bands on Route/Park • Balloonist • Petting Zoo •• $4 BBQ by Crystal Springs • Party Bouncers • Children’s Games •
Saturday, September 22, 2012NIVERVILLE, MANITOBA
Saturday, September 22, 2012NIVERVILLE, MANITOBA
www.imaginementalhealth.comwww.imaginementalhealth.com
Photos courtesy of: Rachel WiebePhotos courtesy of: Rachel Wiebe
MO
NT
HLY
GIV
ING
PR
OG
RA
MM
ON
TH
LY G
IVIN
G P
RO
GR
AM
I’ve enclosed a blank cheque marked V
OID
. I authorize the Imagine G
roup to deduct the amount
I have specified from the account num
ber on the cheque, on the: 15th or 30th of each month.
SIG
NATU
RE
:
DATE
:
NA
ME
:
Box 746
Niverville, M
BR
0A 1E
0C
anada
ww
w.im
ag
ine
me
nta
lhe
alth
.co
m
You may change or cancel your contrib
ution by em
ailing info@m
entalhealthmatters.ca You have the right to receive reim
bursem
ent for any deb
it that is not authorized
or is not consistent with this PA
D A
greement. For m
ore information visit w
ww
.imaginem
entalhealth.com
$5Y
ES, I wan
t to su
pp
ort m
ental h
ealth aw
areness w
ith a m
on
thly g
ift of:
$10$20
$
RU
N 2
01
1B
ecause M
ental H
ealth M
atters
All
dona
tions
of
$10
or m
ore
will
be r
ecei
pted
aut
omat
ical
ly;
othe
rs o
n re
ques
t. B
y sh
arin
g yo
ur e
mai
l ad
dres
s, y
ou a
re p
rovi
ding
us
with
con
sent
to c
omm
unic
ate
with
you
ele
ctro
nica
lly.
Fo
r m
ore
info
rmat
ion
on
how
to
bec
om
e a
mo
nthl
y d
ono
r, p
leas
e se
e o
ver.
I’ve
encl
osed
a c
hequ
e m
ade
paya
ble
to IM
AG
INE
Ple
ase
Cha
rge
my:
$40
$50
$80
$100
$
I am
en
clo
sin
g m
y g
ift
of:
CA
RD
NU
MB
ER
:
NA
ME
:
EXP
IRY
DAT
E:
AD
DR
ES
S:
PH
ON
E:
CIT
Y:P
RO
VIN
CE
:
EM
AIL
:
PO
STA
L C
OD
E:
SIG
NAT
UR
E:
CO
UN
TRY:
YES
, I w
ant
to s
up
po
rt m
enta
l h
ealt
h a
war
enes
sY
ES,
DONATION OPTIONS
Make ALL cheques payable to IMAGINE. Tax receipts will be issued only for donations (not registrations) over $10.
All registrations are NON REFUNDABLE. Please print clearly.
SIGNATURE AGE ON RACE DATE
Drop off this entry at any Running Room location.To register online, go to www.runningroom.com
WAIVERI know that fitness clinics have potentially hazardous activities associated with them. I should not participate prior to approval by my physician. I assume any and all other risks associated with these events including but not limited to falls, contact with other participants, the effects of the weather including high heat and/or humidity, the conditions of the roads, all such risks being known and appreciated by me. Knowing these facts, in consideration of the Running Room Sports Inc., Event Sponsors, Volunteers and Organizers accepting this entry, I hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages sustained by me as a results of this event, for any cause whatsoever, including negligence. It is expressly understood by the undersigned that this event is entered into at the sole risk of the undersigned & that the organizers and sponsors of the event are exempt from liability for any and all damages sustained & any and all injury & loss, including personal & property loss arising from any cause whatsoever, including negligence. Applications for minors will be accepted only with a parent’s signature and should be signed by the minor also. I hereby acknowledge having read this Release and Waiver and I understand and accept its terms.
FIRST NAME
LAST NAME
ADDRESS
GENDER MALE
YES
FEMALE
NO
CITY PROVINCE
POSTAL CODE
COUNTRY
PHONE (HOME)
PHONE (WORK)
EMAIL ADDRESS
DATE OF BIRTH (MM/DD/YYYY)
CAN WE CONTACT YOU ABOUT OTHER IMAGINE EVENTS?
Event
Half Marathon
5K
$55 $80
10K $30
$20
$55
$25
Donation to Suicide Prevention
Payment Method Cash Cheque
$Long Sleeve Tech-Shirt $25LIMITED QUANTITIES - ORDER NOW
Until August 31
AfterAugust 31 TOTAL
TOTAL
S M L XL XXL
Niverville is located 17 Minutes South of Winnipeg. For further descriptions and route map please check out www.imaginementalhealth.ca
Start/Finish Line: Hespler Park - Niverville
Race day registration 7:00 – 8:00 (Cash or cheque only)
Countdown time starts at @ 8:30
Opening ceremonies @ 8:45
The run will start promptly at 9:00 a.m.
Medal Presentation at 11:00 for top 3 male and female finishers. All Finishers will receive medals.
No bikes or rollerblades will be allowed on the course. People pushing strollers will start at the back. The course will take you through newly developed areas of Niverville along with established neighborhoods and a short way through the scenic countryside. For descriptions and route map check out: www.imaginementalhealth.com
Live bands will be located throughout the route. Refreshment & food are available for finishers. There will also be a BBQ for $4.00. Post Race massage therapy will be available for a donation.
This is a timed event, but not an officially sanctioned run. Results will be posted after the race.
STIGMA
- Stop- The- Ignorance.- Gain- Mental- Awareness
On-site registration will be available at these times:
Wednesday, September 19, 6:00 p.m. - 9:00 p.m.Kenaston Running Room1875 Grant Ave. (Winnipeg)Kenaston Village Mall
Thursday, September 20, 4:00 p.m. - 8:00 p.m.John Henry Banquet Hall10 Cedar Drive (Niverville)East end of Main Street
The 2012 Imagine bracelets are available for purchase with a suggested donation of $2.00. Remember to bring all five bracelets to the event for a prize and to be entered to win the grand prize. If you are interested in a 2012 bracelet, contact Imagine via Facebook, Twitter or email Michael Rutherford at [email protected]
IMAGINE EVENT DETAILS R E G I S T R A T I O NOUR MISSION
KIT PICKUP
2012 BRACELETS
Imagine supports those suffering with mental health issues and help the vast number of people who needlessly lie hidden by shame and embarrassment. We want to help so that nobody feels like they need to walk through their struggle alone. We cannot succeed without your help.
To ra i se v i s ib i l i t y and e rase the s t igma surrounding mental health issues and suicide through public awareness campaigns and events
We invite you to join with us in our effort.
