Walk/Run/Bike for Mental Health 

Facts and Sign-Up form 

* The Walk for Mental Health takes place during the entire Month of May 

* It is a virtual event with participants free to set their own walking distance(s) and time(s) to walk 

* Participants determine their own donations and walk by a $ figure for each mile or a single amount for their mileage total

* The Pastoral Counseling Centers of MA is a registered 501 (c)3 nonprofit incorporated in Massachusetts, and your contribution is tax-deductible

* Participants may walk the entire distance at one time or spread it over a number of separate times

* Participants are welcome to walk as individuals or as a group 

* If anyone will be walking with you in a group, please send this form to them

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Walkathon Sign Up Form 

Please mail or scan and email ( jkojbo@aol.com) your completed form to Jane O'Neil at the Lyman Street address below

Name_____________________________________

_____l am using his form for myself        _____ I am part of a group (name_______________________________)  

Address________________________ Phone____________ Email_____________________

I will be walking, running, cycling, a total of___ miles (whether at one time or multiple times) 

My total donation is expected to be $_________

At the outset or completion of your walking, running or cycling, please donate your collected sponsorship dollars by using either of the donate buttons on the website (pccofma.org) or mail a check to Jane O'Neil at The Pastoral Counseling Centers, 18 Lyman  Street, Suite 250, Westborough, MA 01581.

I agree that I am walking, running or cycling on my own accord and The Pastoral Counseling Centers of MA bear no responsibility for my participation. 

Signature_________________________