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HOW YOUR DONATION HELPS This event raises money to support the Children’s Dyslexia Center – Madison in fulfilling its mission of helping local children with dyslexia learn to read and write. Up to one in five school children in the United States are living with dyslexia. While dyslexia cannot be cured, it can be overcome. The program offered at the Children’s Dyslexia Centers offers the most effective treatment of its kind in battling this disorder. No one else in the nation has a program remotely like it with one-‐on-‐one professional tutoring offered to children free of charge. And, to continue providing this valuable program we need your help! You can help us fulfill our three primary goals: • PROVIDE free of charge the highest quality multisensory reading and written language tutorial services for children with dyslexia, through a network of nationally recognized centers of excellence. • PROMOTE and encourage education of tutorial trainees, professionals, and the public, to become resources in teaching children to read. • And, ADVANCE the body of scientific knowledge of dyslexia through support of clinical research, to improve today’s standards and tomorrow’s care. The Children’s Dyslexia Centers are a Scottish Rite Charity. Madison has one of 49 centers and provides services to children in the greater Madison area. All services provided by the Children’s Dyslexia Center -‐ Madison are free of charge, without regard to race, gender, creed, sect, or Masonic affiliation. PLEASE SUPPORT AND THANK OUR SPONSORS Children’s Dyslexia Center Madison -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐Platinum Sponsors-‐-‐-‐-‐-‐-‐-‐-‐-‐ 6th Annual -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐Gold Sponsors-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐Silver Sponsors-‐-‐-‐-‐-‐-‐-‐-‐-‐ The Burish Group Terrance Hankerson UBS Financial Services UBS Financial Services -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐Bronze Sponsors-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Josh Erickson Agency, American Family Insurance Madison Court #7, Order of the Amaranth I've been pleased to serve as
Grand Marshal for the
Walk for Dyslexia for five years
now and am proud to support
this effort to help local
children overcome dyslexia.
–Pat Richter
When: Where: Saturday, May 16, 2015 Henry Vilas Park Shelter House* 702 South Randall Ave. Madison, WI Course: 5K Time: 7:30 am Check-‐in/Registration 8:30 am Start Info: Dale Holmen [email protected] (608) 241-‐4751 Or, visit our website www.walkfordyslexiamadison.org *See directions to Shelter House inside brochure REGISTRATION INFORMATION All participants will receive an official walk T-‐shirt while supplies last. Pre-‐registering guarantees you will receive a shirt. Check or cash only with this form, please. Credit cards are accepted for on-‐line registrations at www.walkfordyslexiamadison.org. Walk Registration will take place at the Vilas Park Shelter at 7:30 am. Walk starts at 8:30 am. Advanced Reg. Fee for Adults: $20.00 Payment must be received along with the entry form before May 8th. Event Day Reg. Fee for Adults: $25.00. Team Advanced Reg. Fee for Adults: $15.00 . A team must consist of five or more adults and children. Group registrations must be in the same envelope and must be received by May 8th. Please enclose a list of all team members. Children 12 and under: $5. Door Prize Drawings: All registered walkers are eligible and must be present to win. Directions to Vilas Park Shelter 1) From I-‐90 take Hwy 12/18 (Beltline) West, take the Park Street exit (Hwy US 151), go North on Park Street to Vilas Ave (at intersection of Park and W. Washington Ave -‐ look for a BP Station), turn left onto Vilas Ave and follow it to Edgewood; Turn left on Edgewood & continue to the Shelter. 2) The Henry Vilas Zoo address is 702 S. Randall Avenue. From the zoo entrance take Drake to Grant to Vilas to Edgewood – left on Edgewood to Shelter. 3) Or, take Monroe Street to Edgewood to Shelter. Visit our website for a Google Map link: www.walkfordyslexiamadison.org PLEDGE FORM Walker’s Name: _________________________ Team Name: ___________________________ Fundraising Goal: $__________________ • Children’s Dyslexia Center -‐ Madison is a 501(c)3 non-‐profit organization. Pledges are tax deductible. • Please collect your pledges and submit when you check in on the day of the Walk. Checks are to be payable to: Children’s Dyslexia Center -‐ Madison. Pledge Awards Participants who turn in pledges on or before the day of the walk will receive a USB thumb drive while supplies last. In addition, gift cards will be awarded for pledges raised as follows: $250 to $499 in pledges ..........$25 gift card $500 to $999 in pledges ..........$75 gift card $1000+ in pledges ...................$125 gift card Gift cards will be Buy Dane Local with a special offer of 20% discount when used at Mystery to Me book store where any type of book can be ordered for you. You may list your pledges below (please print). Continue on a separate sheet of paper as needed. Or visit our web site (www.walkfordyslexiamadison.org) for a pledge sheet to record additional pledges. Name ____________________________________ Address __________________________________ Email:_____________________________________ Amount $ _____________ Name ____________________________________ Address __________________________________ Email:_____________________________________ Amount $ _____________ REGISTRATION (YOU CAN ALSO REGISTER AT WWW.WALKFORDYSLEXIAMADISON.ORG.)  I plan to participate in the Walk. Enclosed is my registration fee of $20 for adults, $5 for children under 12.  I am registering Team Member(s). Enclosed are registration fees of $15 for _____ adults ($5 for ____ children under 12). Team Name: ____________________________________ Please enclose list of names of team members.  I cannot attend, but enclosed is my donation of $________.  I would like to volunteer the day of the Walk. Please contact me at the phone/email below. Participants will receive a commemorative T-‐shirt. Please indicate size(s). Adult sizes are unisex shirts. ___ Child Medium ___ Child Large ___ Adult Small ___ Medium ___ X Large ___ XX Large ___ No T-‐shirt(s) needed ___ Large Complete and sign below; send with your payment to:
Gail Piper
1909 E Dayton St., Madison WI 53704
Checks are to be made payable to:
Children’s Dyslexia Center – Madison
Please Print
Name:___________________________________________
Address:________________________________________
_________________________________________________
Phone:____________________________________
Email: ____________________________________
____________________________________________
Emergency Contact & Phone Number
Participant Liability Agreement: Please enter me in the “Walk for Dyslexia-‐Madison”. I, on behalf of myself, my heirs, executors, and administrators hereby release the Children’s Dyslexia Center -‐ Madison from any and all claims, damages, and rights of action I may have, present or future that may arise out of, or be incident to my participation in the Walk event. In addition, I grant permission for the use of my name and/or picture in any photograph, film or videotape of the event for any purpose. ________________________________________________________ ________________________________________________________ Name ____________________________________ ________________________________________________________ Address __________________________________ ________________________________________________________ Email:_____________________________________ Amount $ _____________ Signature(s) (All participants must sign.) NOTE: If participant is under 18 years of age, parent or guardian must sign. This agreement must be signed for your Registration(s) to be entered