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This site is not intended as a crisis or hotline web site. Local crisis
hotline numbers can be found in the front of your NATIONAL SUICIDE PREVENTION HOTLINE 1 800 273 TALK OR 1 800 273 8255
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Breaking the Silence... WALK 2003 Breaking the Silence Walk 2006 Donations/Donor Campaign
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Saturday, October 11, 2003 - Kapi'olani Park, Check-in: 7:00 am, Starts: 7:30 am. In Support of Suicide Prevention Awareness Programs I understand as a family member, friend or supporter of "In Memory of...Kaniela Kaninau and other loved ones", I am participating in support of: SUICIDE PREVENTION/SAVE LIVES THROUGH… Ø Increase awareness of "Suicide Prevention Programs" Ø Increase awareness of support programs for "Survivors of Suicide Day" Ø Provide educational programs to raise "Suicide Prevention Awareness" levels of all individuals Ø Provide training for individuals to recognize risk signs of a potential suicide crisis with information on what to do next Saturday, Oct. 11, 2003 "Breaking the Silence...Walk" We've just begun!
Participants receive:
REGISTRATION FORM Personal Information *Include a $20.00 Registration fee. First Name: ___________________________ MI: ____ Last Name: _________________________ Address: ______________________________________ Apt./Rm./Suite #: ____________________ City: ___________________________________ State: ______________________ Zip: ________ Email: ____________________________________________________________________________ Home Phone: _________________________________ Day Ph. Contact: _____________________ Cellular Ph.: ___________________________ Fax: _______________________________________ Company: _________________________________________ Business Ph.: ___________________ Alternate Address: ______________________________ City: _______ State: ____ Zip:___ Gender: __Female __Male Birthdate: __ __/ __ __/ __ __ __ __ T-Shirt Size: Regular quarter sleeve: Please circle one: xs small med. large xlarge xxlarge xxxlarge Or Tank: xs small med large xlarge xxlarge xxxlarge Print Name: _____________________________ Signature: _________________________ Date___ Mail to: Hawai'i S.P.E.A.R. Foundation of America, 747 Kapahulu Ave. #10, Honolulu, HI 96816 Check made payable to: Hawai'i SPEAR Foundation of America
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*Hawai'i S.P.E.A.R. Contact # (808) 271-8582 2630 Maunawai Place, Unit C, Honolulu, Hawai'i 96826
Send mail to hawaiispear@aol.com with questions or
comments about this web site.
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