Walk for training, workshops, and education, outreach and support groups. You can help stop the stigma related to suicide in your community. Sunday, September 19^, 2010, DuBois City Park on Liberty Boulevard

Volunteer Sign-Up Form

Clearfield Jefferson Walk for Suicide Prevention & Awareness

Please indicate your interest in helping with the Clearfield Jefferson Walk for Suicide Prevention & Awareness:

® I would like to volunteer to work the day of the Walk:

― Setting up

― Registering walkers

― Serving refreshments

― Cleaning up after the walk

® I would like to help get other people and businesses involved.

® I would like to help promote the Walk by presenting at a place of business, group or organization.

® I would like to help in other ways.

® I would like to support Clearfield Jefferson counties Suicide Prevention Team by making a fundraising donation

in the amount of $____________. (A receipt will be sent to you following the walk.)

Full Name (print):_________________________________________________________________

Address: ________________________________________________________________________

Phone: _________________________________Email:____________________________________

Return by mail, email or fax to:

Clearfield-Jefferson Suicide Prevention Team

Attention: Mary Brown

PO Box 344 DuBois, Pa. 15801

Phone: 814-265-1060 ext. 330

Email: mbrown@cljmhmr.com

Fax: 814-265-1049