03/05/2012
Breaking the Silence of Sexual Violence
Connect. Respect. Prevent Sexual Violence.
5 Mile Run or 2 Mile Walk
Date: April 28th Walk: 9:45 am Run: 10:00 am
Registration: Registration will begin at 9:00 am at the Maliseet Gym in Houlton located on Foxcroft Road. Participants will have access to changing/restrooms.
Course Information:. The Course will begin at the Maliseet Gym and follow a 5 mile / 2 mile course on the Foxcroft road to a turnaround location.
Award Ceremony: Award ceremony held at 11:15 AM
Snacks, water and sweet treats will be available during this time
Walking Category Awards: First 5 walkers
5 Mile Run Category Awards: (M & F) 14 and under, 15-18, 19-29, 30-39, 40-49, 50-59, 60+
5 Mile Relay: First Relay Group to finish
Kids Race Awards: (M & F) age categories TBA on race day, participation medals will also be awarded
Contact: Katie Bell at 207-532-3000 OR Bonnie Dickison at 207-532-6523
E-Mail: [email protected]
This Event is Co-Sponsored By:
AMHC Sexual Assault Services
AMHC Sexual Assault Services is a free and confidential service that supports victims of sexual violence throughout Aroostook County. We provide community education, prevention and advocacy services as well as support groups for survivors and a 24 hour support line. If you or a loved one have been impacted by sexual violence and would like to speak to an advocate call us at 1-800-550-3304.
Maliseet Domestic Violence and Sexual Assault Services: The Maliseet Domestic Violence and Sexual Assault Program is dedicated to ending violence against Native women by assisting victims in regaining personal safety and control of their life, ensuing accountability of perpetrators of violence within the Tribal and non-tribal Law enforcements and judicial systems, and promoting peaceful relations in our Tribal families and Community. Services provided include; Unconditional/Confidential Support, Crisis Intervention, Safety Planning, Emergency Shelter and related assistance, Support Groups and Accompaniment and Advocacy services. For more information contact (207) 532-3000 or contact the hotline at (207) 532-6401.
Aroostook Musterds The Aroostook Musterds Running Club is an organization dedicated to running and road racing. A Musterd believes in the importance of physical fitness and is committed to upholding all rules of courtesy and sportsmanship. He/she displays a toughness of mind and spirit traditionally characteristic of "The County".
5 Miler T-Shirt Fee:
Children 12 and under: $5.00
12-64: $10.00
Seniors 65+: $5.00
Checks Payable to: Maliseet DVSA
Mail Entry Form to:
Maliseet DVSA
Attention: Katie Bell
690 Foxcroft Road
Houlton, Maine 04730
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Breaking the Silence 5 Mile Run/2 Mile Walk PLEASE PRINT
(Fill out and send in this portion with payment)
Name ________________________________
City/Town ___________________
Ph Age on Race Day_____
E-mail address _________________________________(this information is not shared)
(Circle one) M F
Event (circle one) RUN WALK KIDS RACE (12 and under)
Are you participating in 5 mile relay (circle one) Y N
Relay Group: 1.) _________________ 2.) _________________ 3.) _________________
Are you representing a group/organization/agency? _________________________
Shirt Size (circle one) Youth Sizes: YS YM YL
Adult Sizes: S M L XL XXL
* T-Shirts are limited to pre-registered runners & walkers and first come first serve on race day.
Waiver and Release of Liability
In consideration of my participation in this event, I for myself, heirs, executors, and administrators, waive all rights and claims for damages I may have against Aroostook Mental Health Center, The Maliseet Domestic Violence and Sexual Assault Program, the sponsors of this event, their agents, representatives, successors and assignees for any and all injuries suffered by me or my child at said event or which may arise out of my traveling to, participating in, and returning from this event. I further state that I am in proper physical condition to participate in this event.
I have read and accept the terms of this waiver on this page.
_________________________________________________ Date ____________
Participant
_________________________________________________ Date ____________
Parent or Guardian signature if under 18
Photo Release: (Please Select One)
I Authorize / DO NOT Authorize the use of my photos from pictures taken at this event.
_________________________________________________ Date ____________
Participant
_________________________________________________ Date ____________
Parent or Guardian signature if under 18
Thanks for your Support in Ending Sexual Violence!
