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Deaf-Blindness didn’t stop with Helen Keller “Alone we can do so little; together About HKNC Enjoy
Deaf-Blindness didn’t stop
with Helen Keller
“Alone we
can do
so little;
together
About HKNC
Enjoy the beauty of Sands Point
as you run/walk with a purpose –
to support people who
live without sight and sound.
we can
do so
The Helen Keller National Center for
Deaf-Blind Youths and Adults (HKNC) is
the only national nonprofit agency that
provides vocational and independent
living skills training exclusively to youths
and adults who have combined vision and
hearing loss.
much.”
— Helen
Keller
Through its headquarters in Sands Point,
New York, and eleven regional offices
across the country, HKNC offers a myriad
of comprehensive services to individuals
who are deaf-blind, their families, and the
professionals that serve them.
Sunday,
September 22, 2013
5K/3.1 Miles
HKNC is operated by Helen Keller Services
for the Blind, a nonprofit 501 (c) (3).
For more information, please visit our
website at www.hknc.org.
PRESENTED BY
Helen Keller National Center for
Deaf-Blind Youths and Adults
REGISTRATION INSTRUCTIONS Helen’s Run/Walk Registration Form September 22, 2013 1. Online: Fee: $25.00 per participant Deadline:
REGISTRATION INSTRUCTIONS
Helen’s Run/Walk Registration Form
September 22, 2013
1.
Online: Fee: $25.00 per participant
Deadline: Friday, September 20, 2013
Visit www.hknc.org and click on the link to register
online or click on the QR code above. Requires
payment by Visa or MasterCard. A processing fee
is added. Children under age 18 may not register
online (although their parents may do so for them).
Official Start 9:00 a.m. SHARP!
Complete and mail this portion with your payment.
(Please print legibly)
First Name: _____________________________________
2.
By Mail: Fee: $25.00 per participant
Deadline: Must be postmarked by Friday,
September 13, 2013
Complete the application form and mail it with
your check, payable to HKNC
Send to: Helen Keller National Center, Attn: Development
141 Middle Neck Road, Port Washington, NY 11050
Please do not send cash; only checks accepted.
Last Name: _____________________________________
Address: _______________________________________
City: ___________________________________________
Waiver for Helen’s Run/Walk 2013
3.
Event Day*: Fee: $35.00 per participant, 7:30-8:30 a.m.
Please read carefully and sign at the bottom.
State:
Zip: _____________
No registrations will be accepted after 8:30 a.m.
*SPACE PERMITTING: check website for availability
before coming.
Age on 9/22/13:
Gender: M
F __
Please Note:
• Registration includes: One T-shirt and refreshments.
• Each athlete must fill out a separate application.
• Fee is non-refundable and non-transferable.
• Event will be capped at 400 entrants.
Physically challenged
Email: __________________________________________
ALL PARTICIPANTS ARE URGED TO REGISTER
PRIOR TO EVENT DAY
Daytime Phone: _________________________________
Walkers/Runners: Individuals of all ages and disabili-
ties are welcome to participate. Participants under 18
years of age must have waiver signed by a parent or
Cell Phone: _____________________________________
legal guardian. *Baby Strollers/joggers, skateboards,
bicycles and pets are not allowed on the course.
___
I would like to include
an additional tax deductible
Award Categories: Awards to the first three male
and female winners in each age category: 14 & Under,
15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49,
50-54, 55-59, 60-64, 65-69, 70+.
Plus: First overall male and female finishers. First
physically challenged male and female finishers.
donation to support HKNC:
$ __________________
In the Helen Keller National Center’s (HKNC)
Helen’s Run/Walk, starting at Sands Point Park
and Preserve and going across Middle Neck Road
and into Sands Point on Sunday, September 22,
2013, I hereby assume full responsibility for the
risk of bodily injury, death or property damage, and
hereby release, waive, discharge, and covenant not
to sue the State of New York, Town of North Hemp-
stead, Village of Sands Point, Sands Point Park
& Preserve, and the Helen Keller National Center
or their respective successors, assigns, officers,
directors, employees, and agents for any and all
loss or damage and any claim or damage there-
fore, on account of injury to my person or property,
whether caused by negligence, breach of contract
or otherwise arising out of resulting from any act or
omission, while I am traveling to or participating in
the 2013 Helen’s Run/Walk.
Total Amount Enclosed:
$ __________________
Signature of Participant:
Make check payable to HKNC, and mail registration to:
HKNC, Attn: Development
141 Middle Neck Road, Sands Point 11050
_____________________________
Date: __________
Directions: LIE to Exit 36/Searingtown Road North.
The Sands Point Park & Preserve is located
approximately 6 miles north of the LIE on the right
hand side of Middle Neck Road.
*Parent/Guardian Signature:
*Must be postmarked by Friday, September 13th.
Otherwise, register day of event between
7:30 a.m. - 8:30 a.m. Pre-registration highly advised.
_____________________________
Date: ___________
Race timing by FINISH LINE Road Race Technicians
of Port Washington.www.FLRRT.com
To sponsor a walker/runner or become a sponsor,
call 516-944-8900, extension 1310.
*SPACE PERMITTING: check website for availability
before coming on event day.
*Entrants under the age of 18 must have a
signature of a parent or guardian.