Bereaved Parents of the USA 2018 National Gathering Registration Packet
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Bereaved Parents of the USA
2018 National Gathering
Registration Packet
Whispering Woods Hotel and Conference Center
7300 Hacks Cross Rd,
Olive Branch, MS 38654
For more information contact:
Jodi Norman, Gathering Co-Chairperson
(703) 656-6999
e-mail: bpusagather@gmail.com
National BP/USA Website:
http://www.bereavedparentsusa.org2018 BPUSA NATIONAL GATHERING CONFERENCE
“Whispers of Hope”
This document contains essential information – please read to the end before registering!
Many of us have found the grief journey more bearable when shared with those who understand. Some have been on this
journey for years while others have barely begun. Hand in hand we walk this road together, offering one another support and
hope. We are honored to share this weekend with you, knowing you will be touched in some way through your experience,
whether by a speaker, a workshop, a song, or a “fellow traveler” seated next to you at a meal. Please join us the weekend of
August 3-5, 2018 as we share Whispers of Hope in memory and honor of our loved ones.
Gathering Speakers and Performers: We are excited to announce our tremendous speakers for the 2018 National BPUSA Gathering:
Mitch Carmody, Ann Irr Dagle, Stephane Gerson, and Pam Vredevelt. Our speakers will follow our meals on Friday and Saturday,
and all are invited, regardless of meal attendance. We are equally excited that the Signing Choir “Love In Motion” will be performing their
inspirational songs of love, loss and healing through sign language. Alan Pedersen will be singing “Tonight I Hold This Candle” at the
Candle Lighting Ceremony on Saturday night.
Thursday Night Activities: While the 2018 BPUSA National Gathering officially begins on Friday, August 3rd, we have planned very
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special activities for Thursday, August 2 for those attendees arriving early. We will be hosting a “Meet and Greet” with Alan Pedersen,
Denise Ganulin and Mitch Carmody providing us with a one-of-a kind very special concert. A Memphis BBQ will be available for $30 all-
inclusive starting at 6 p.m.
Hotel Accommodations: The Whispering Woods Hotel and Conference Center will be providing a discounted rate of $110 per night
(plus tax), and will honor this rate for 2018 National Gathering guests for 3 days before and 3 days after the Gathering (July 30
– August 7), come early or stay late to experience all that Memphis has to offer! Book your reservation early on our personalized
website:
Please go to www.wwconferencecenter.com and enter the code BPOU to book your reservations. If you have any questions or
problems making reservations on line, please contact the hotel directly at (662) 895-2941 or (662) 890-2885. If you have any
special requests, such as handicap accessible, email any requests or questions to reservations@wwconferencecenter.com or
ljeffries@wwconferencecenter.com
Please use our personal website and NOT the Whispering Woods Hotel website to book your room. Link directly to the hotel for
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reservations through the BPUSA National website. Friday, June 29 at midnight is the deadline to book hotel reservations at the
discounted rate. If you need to call the hotel the number is (662) 895-2941. Please make your reservations as soon as possible and
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before the deadline as they may not honor the discounted rate after June 29 , it will be based on availability!
Cancellations: You may cancel your hotel reservation for full deposit refund charge up to 72 hours prior to your arrival date.
Bookings: All reservations must be charged 1st nights room and tax 72 hours of arrival. Valid credit is required.
Travel: If traveling by air, book your flight into Memphis International Airport. Whispering Woods provides complimentary shuttle
to and from the airport. Please call the hotel prior to your arrival with your flight information. The airport is approximately 25
minutes from the hotel. Plan your flights accordingly as we encourage you to attend the Gathering from Thursday evening through
Sunday at noon. If you are a leader, Chapter Leadership Training starts early Thursday morning. Book your flights as soon as
possible!
If you are driving, the hotel provides free parking.
Meals: We believe that the camaraderie and bonding during shared mealtimes is a vital and significant part of your
Gathering experience; therefore, we highly recommend the conference meal plan. To make it as easy as possible for you
to join us at each of the meals, we work to keep prices affordable. This year’s meal plan cost breaks down to less than
$25 per meal with tax and tip included.
Total Meal Plan (Fri-Sun which includes 3 breakfasts, 2 lunches and 2 dinners) is a discounted rate of $160. Prices include tax and
gratuity. Individual meals will be available to purchase; however, the meal plans will save you $40! All attendees are invited to join us
following the meals. We don’t want anyone to miss the messages of hope delivered by each amazing speaker. Please advise us of any
special dietary needs, as the hotel will accommodate requests for Gluten Free, Diabetic, Vegetarian, Vegan, etc.
Children’s Meals: There is no reduced rate for children for the buffet meals. However, we are offering for children, 12 and under,
the option of child-friendly meals for $100 for all seven meals. Please advise us of any special dietary needs for your child.
Sibling Program: We welcome siblings ages 8 to adult at the Gathering and offer sibling-specific programming. Each workshop
time slot will feature at least one workshop devoted to the particular experience of bereaved siblings. Sorry, we are unable to
provide babysitting for younger children.
Workshops: A variety of workshops are offered in a structured setting facilitated by a skilled presenter and designed to address specific
topics. This is also a time of learning and sharing. If you are interested in presenting a workshop at the Gathering, please go to the BPUSA
website to submit an application. Deadline to submit an application is March 1, 2018.
Sharing Sessions: These are informal meetings led by a facilitator and are offered Friday and Saturday evenings. Participants share
experiences on specific topics.
Yoga: We will be offering yoga classes again this year so don't forget to pack loose-fitting clothing. If you have a yoga mat, it is highly
recommended that you bring one with you.Slideshow Presentation: This occurs during the Candlelight Service, which is a meaningful part of our Gathering each year. Please
send a photo of your child (alone in the picture), no larger than 8x10, and the completed form, to the address listed at the bottom of that
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form, no later than July 1 . Photos may also be sent via e-mail in jpg format to bpusaweblinks@gmail.com no later than July 15 or
uploaded on the electronic registration form.
Sponsorships: We are offering a number of opportunities this year for those who wish to have their child(ren) remembered in a special
way during the Gathering. Sponsorships enable individuals, chapters and businesses to support the Gathering as well as remember their
loved ones. As you may know, we count on all sponsorships to aid in the cost of the Gathering each year so we can use your help. You
are free to participate in as many of the sponsorship opportunities available to you as shown below.
Sponsorship Opportunities:
Sponsor a Page in the Gathering Program Book: Fill out the form included in this packet for your Child(ren)’s Memorial Sponsorship
Page to be published in the program book. Mail or email the form with your page layout, print ready, to Peggy Williams, at the address
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on the form. The deadline to guarantee your child’s picture is included in the program book is June 1 . The cost for a full page is
$100, a half page is $50 and a quarter page is $25.
Advertise in the Program Book: Are you a business owner? An author? A singer/songwriter? Please place an ad in our Program
Book. Full page $300, half page $150, quarter page $75, business card $25. Please use the form included in this packet.
Sponsor a Workshop Room: At a cost of $50, a sign will be professionally made which will include your child’s name, picture, and
the person(s) sponsoring each workshop room. It will be displayed on an easel outside the door of the workshop room for the entire
day. Please indicate your participation on the registration form and send a picture, no larger than 8x10, to Melanie Groves, 1190
Worthington Drive, Bridgeport, WV 26330 or email a photo in jpg format to melanie.e.groves@gmail.com. The sign is yours to keep
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at the conclusion of the Gathering. The deadline is July 1 .
Sponsor a Centerpiece: We are asking for a $35 donation per centerpiece. Your child’s name and photos will be displayed with the
centerpiece during the entire Gathering. You are welcome to take the centerpiece with you when you leave on Sunday. Please email
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a photo of your child to Melanie Groves at melanie.e.groves@gmail.com, no later than July 1 .
Table Favors: Table favors are small items placed on the tables during our meals. These are donated by parents or chapters in
memory of their child or children. We need approximately 300 items for each meal. If you would like to donate table favors, please
contact Jodi Norman at bpusagather@gmail.com or call her at (703) 656-6999.
Tote Bag Items: Donate items for the tote bags which are given to all attendees. Donations of such items as pens, note pads, tissue
packets, water bottles, candy, etc. are greatly appreciated. If you or your chapter would like to make a donation, contact Melanie
Groves at melanie.e.groves@gmail.com.
Bookstore: The Centering Corporation will provide a complete bookstore with a vast variety of materials including books, CD’s and
DVD’s, many authored by our speakers, workshop presenters and performers who will be available to autograph them at a designated
time. Any Gathering Speaker or Workshop Presenter who have published books, please contact Janet at Centering Corporation at (866)
218-0101, if you would like to have your books available for sale at the Gathering.
Butterfly Boutique: We will be providing a small gift shop at the Gathering. We are looking for donations of small items that would sell
for $20 or less. Handmade items are especially sought after. Suggestions for items (but not limited to) are butterfly and angel related note
cards, jewelry, candles, magnets, sun catchers, photo frames or albums, bookmarks and journals. Anyone interested in donating items,
contact Jodi Norman at bpusagather@gmail.com.
Silent Auction and Raffle: We will be having a silent auction and raffle to raise funds to support ongoing national efforts of BPUSA.
Donations in memory of your child(ren) are greatly appreciated and welcomed. Please contact Becky Russell, (501) 831-5200 or email:
becky.russell@live.com for more information. Some of the popular items from past raffles/silent auctions are butterfly or angel themed
items such as jewelry, handbags or artwork; gift cards for national chain restaurants and services; and themed baskets, just to name a
few. Higher value items such as trips, handmade quilts, original artwork, signed sports items (Jerseys or sports equipment) from famous
athletes and teams are also greatly appreciated.
T-shirts: T-shirts are available to purchase for $25 or you can receive a t-shirt with your child’s photo on the back of the shirt for a $30
donation to the “Walk towards Hope and Healing.” Please indicate on the registration form if you would like to purchase a t-shirt or on the
“Walk Toward Hope and Healing” registration form for a t-shirt with your child’s picture (picture submitted for the slide show will be used
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on the shirt). Deadline to order t-shirts is July 1 .
Creation Station: You will be able to do craft projects in our Creation Station. Bring photos of your child to use in different projects. We
will have a copier and a printer available to make copies of your pictures, if needed. You will be able to decorate and personalize a votive
for Saturday Night’s Candle Lighting.
BPUSA Rocks Memphis: We are painting rocks to "hide" around the Gathering with the sole purpose of spreading joy and brightening
people's day. It is meant to inspire creativity in all ages and a way to remember our children. Rocks will be available to paint in the Creation
Station or bring painted rocks with you to get the fun started! On the back of your rock please reference the Facebook group
"@BPUSAROCKSMEMPHIS." We can't wait to spread the joy!!!
Memorial Templates: Enclosed in this packet is a template of a heart to decorate in memory of your loved one. Be creative!!! Bring it
with you to be displayed so that we can all get to know your child who is “Forever Loved – Forever Missed!” Put your child’s name and
dates on the front. The template is also available to download and print on the website www.bereavedparentsusa.org. If you would like
to have your template displayed and are not attending the gathering, they can be mailed to Jodi Norman, 539 Harrison Circle, Locust
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Grove, VA 22508 to be received no later than July 15 .Picture Buttons: Each attendee will receive one picture button included in their registration fee. Additional buttons can be ordered at a
fee of $5 per button. It is highly recommended that you preorder any additional buttons. Please indicate the number of additional buttons
on the registration form. The picture that you send for the slide show will be the photo used for the free button. If you would like to
use a different photo for your additional buttons, please send a picture or pictures via e-mail to bpusagather@gmail.com in jpg format
and indicate on the order form how many picture-buttons you would like. We will have a picture-button maker at the Gathering. If bringing
a picture with you to the Gathering, a clear photo is best because they will be scanned into the computer and picture-buttons will be made
from the scanned copy.
The Hospitality Area: A social gathering spot to enjoy light snacks and beverages and/or a place to take a break from the busy schedule
and catch your breath while you visit with other bereaved families.
Reflection Room: A peaceful and serene room to reflect and meditate.
First Annual Memory Walk: Join us on Sunday morning at 8 a.m. for a “Walk Towards Hope and Healing” in memory of our children,
siblings and grandchildren. Spend a little time outside on the beautiful grounds of Whispering Woods and walk for a good cause! Solicit
family and friends to sponsor your walk. Chapter members are encouraged to create banners to carry during the Walk. Please see all
the details on the BPUSA Memory Walk Fundraiser form included in this packet.
We have made it easy to ask for donations via our new Classy.org websites. Chapters are encouraged to create a team and then chapter
members become a part of the chapter’s team. If you are not a part of a chapter, please form your own team or participate as an individual.
To join in on the fundraising via the “Walk towards Hope and Healing” website go to https://www.classy.org/campaign/walk-towards-hope-
and-healing/c162565 to set up your team and page. If you have any questions regarding the website, contact Jodi Norman,
bpusagather@gmail.com or call her at (703) 656-6999.
Signs along the walk can be sponsored in memory of your child, sibling or grandchild for a $50 donation. The photo submitted for the
slide show will be used on the walk sign. Any questions regarding the signs, please contact Melanie Groves,
melanie.e.groves@gmail.com or call her at (304) 842-1916.
End of Gathering: We will conclude Sunday around noon and you won’t want to miss anything as we wrap up another Gathering until
next year. Following our First Annual “Walk Towards Hope and Healing” there will be a touching closing ceremony – a beautiful ending
to an amazing weekend shared with families and friends, both old and new.
Photographs and Video: Photographs and/or video will be taken at the Gathering. By taking part in the Gathering you grant BPUSA full
rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising,
publicity or other purposes to help achieve the goals of BPUSA. This might include (but inot limited to), the right to use them in our printed
and online publicity, social media, press releases and funding applications. For children under the age of 18, a form will need to be signed
at Registration at the Gathering.
Dressing for the Gathering: The dress is casual and the weather will be hot in Memphis, however, you will want to bring a sweater
as the hotel workshop rooms can be chilly.
Important Deadlines
March 1st– Workshop Presenter Applications Due
June 1st– Early Bird Discount Ends
June 1st– Memorial Pages Due
June 29th at Midnight – Deadline to make hotel reservations
July 1st – Deadline to submit photos via mail for sponsorships and for the slide show.
July 1st – Deadline to order “Walk” signs and T-Shirts
July 15th – Deadline for Heart Templates to be received if mailing them.
July 15th – Deadline to submit photos via upload or email for slide show.
If you are a Chapter Leader:
• Make copies of this registration packet to give to your chapter members as soon as possible.
• As a chapter, donate table favors for the Gathering meals.
• As a chapter, donate a theme-basket or an item for the Silent Auction or Raffle.
• As a chapter, donate an item to put in the tote bags given to every attendee. We will need approximately 300 items.
• Make a banner to carry in the “Walk towards Hope and Healing” with the names of your chapter’s children.
• Get with your chapter members and decorate your memorial template for displaying at the Gathering.
• Plan to attend the Leadership Training on Thursday, August 2nd. (Scholarships Available)2018 BPUSA NATIONAL GATHERING
REGISTRATION FORM
*Please complete ONE FORM for EACH PERSON attending
Name: ________________________________________________________________________________________
Address: ___________________________________________ City: ________________________________________
State: ______ Zip: ___________ Tel. # (_______) ____________ Email: _________________________________
Child’s Name: _________________________________ Child’s Name: ____________________________________
Birth Date: ____________ Death Date: ____________ _ Birth Date: _______________ Death Date: _____________
Your relationship to this Child: ___________________ __________________________
If you are a sibling, what is your age? ____________
Early Registration Postmarked BY JUNE 1st is $75 per adult, $50 for College Students with ID and $40 for children under 18.
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If postmarked after June 1 , the registration fee is $95.00 per adult.
Please register as EARLY as possible for planning purposes, and to get the BIGGEST SAVINGS on fees!
ITEM QTY. PRICE TOTAL
Registration Fee (see above) Register EARLY for the best price! each
Meal Plan (Friday-Sunday: 3 breakfasts, 2 lunches, 2 dinners) $160.00
Children’s Meal Plan $100.00
Thursday Dinner $ 30.00
Individual Meals:
Friday Breakfast $20
Friday Lunch $30
Friday Dinner $40
Saturday Breakfast $20
Saturday Lunch $30
Saturday Dinner $40
Sunday Breakfast $20
Sponsorship of a Workshop or Sharing Session $ 50.00
Sponsorship of a Centerpiece $ 35.00
Sponsorship of a Memorial Ad ($100, $50, $25)
Business Ad ($300, $150, $75, $25)
Additional Picture Buttons $ 5.00
T-Shirt, Sizes S-5X: Size _______ $ 25.00
T-shirt with Child’s Photo, Sizes S-5X: Size_______ $ 30.00
“Walk Towards Hope and Healing” Sign $ 50.00
TOTAL AMOUNT DUE $
Special Diet Needs and/or Food Allergies (explain in detail): ______________________________________________
_________________________________________________________________________________________________
Send this completed Registration form (ONE FOR EACH PERSON attending) AS EARLY AS POSSIBLE and
your check or money order made payable to BPUSA NATIONAL GATHERING to:
Cheryl Sanza, Treasurer
10 Robert Dr
Florida, NY 10921
Phone: (845) 651-7746
or register online at www.bereavedparentsusa.orgMemorial Sponsorship Page Form Sponsoring a memorial page in the Gathering program book is a meaningful way to remember our precious children, brothers/sisters, and grandchildren. Design your page around your child’s picture or your memories of them. The memorial pages will be in color. If you do not include a page design with your donation, the Program Book Committee will create a design for you. Name of person placing memorial page: ______________________________________________________ Address: _______________________________________________________________________________ City: _____________________________________ State: ________________ Zip:____________________ Phone #____________________ Email: ______________________________________________________ Please check the memorial page size you would like: q Quarter Page (3.6” x 4.9”) $25.00 q Half Page (7.5” x 4.9”) $50.00 qFull Page (7.5” x 10”) $100.00 Enclosed* amount: $_____________________ All memorial page entries must be received with payment NO LATER than JUNE 1, 2018. *Note: If you paid for your memorial sponsorship page when you registered online, you do not need to send payment with this form. The program book will be printed in 8-1/2” x 11”-page format. Please use these dimensions when creating or selecting your memorial page size. Your materials must be mailed so that we receive them NO LATER than JUNE 1, 2018. Please make checks payable to BPUSA National Gathering and mail to: Peggy Williams 221 NE 3rd St. England, AR 72046
Instructions for Submitting Information for
Your Child’s Memorial Sponsorship Page
Here’s what we need from you:
• A completed Memorial Sponsorship Page Form.
• Your design for the page or portion of the memorial sponsorship page.
o If you wish the Program Book Committee to design the page for you, you may skip this step.
o If you prepare your own design and submit it “Print-Ready” we would prefer to receive it in
digital format with a resolution of 300 pixels per inch or higher. It may be submitted as an
Adobe PDF file, an MS Word file, an MS Publisher file, a JPG file, or a TIF file. It may be
sent to us as an attachment to an email or by mail on a flash drive, a CD, or a DVD.
o You may submit your design as a “Print-Ready” page, printed at a high quality so that it will
look good when reproduced by photocopying.
• Requirements for any photo(s) which are to appear on your memorial page:
o Digital photo file(s). The best format is a JPG file. Be sure the resolution is at least 300
pixels per inch!
o If you don’t have a JPG file(s) of the photo(s), you can take the original photo(s) to a copy
center such as Fed Ex/Kinkos, Office Depot, or Staples. They can scan the photo and
create the JPG file for you.
o Original photo(s), which we can scan and return to you. Please do not send a printed
photocopy or inkjet printout of a picture. They do not scan and reproduce well, and will
result in a poor quality for your page – you don’t want that – nor do we!
o If you are submitting a “Print-Ready” version of the memorial page, you do not need to
submit the photo(s).
• Send to us by email or mail:
o Your completed form
o Any special instructions
o Your design
o The desired text
o Your photo(s)
If sending by e-mail:
Send to Peggy Williams at pegwill53@gmail.com
Please include “Memorial Sponsorship Page” in the subject line.
Include your name, address and phone number in the text so we can easily contact you if we need more
information. Your email with all the information and photo(s) must arrive no later than June 1st.
If sending by mail:
Make checks payable to BPUSA National Gathering.
Mail to: Peggy Williams, 221 NE 3rd St., England, AR 72046
The package must be mailed in time so that we receive it no later than June 1st.
Questions? Please call Peggy Williams at (501) 804-3560.BUSINESS SPONSORSHIP PAGE FORM
Thank you for sponsoring a business ad in our Gathering Conference Program Book.
With your help, we can continue the important work of providing support,
understanding and education to grieving families across the United States.
Business name: ___________________________________________________________________
Contact name: ____________________________________________________________________
Address: _________________________________________________________________________
City: _____________________________________ State: ________________ Zip: ______________
Phone #____________________ Email: ________________________________________________
Please check the size you would like for your business page ad:
q Full Page $300.00 q Half Page $150.00 q Quarter Page $50.00
q Business Card $25.00
Enclosed amount: $_____________________
Please submit your ad “Print-Ready” with a resolution of 300 pixels per inch or higher in a JPG format.
It may be sent to us as an email attachment or by mail on a flash drive. Deadline is JUNE 1, 2018.
If sending by e-mail:
Send to Peggy Williams at pegwill53@gmail.com
Please include “Memorial Sponsorship Page” in the subject line.
Include your name, address and phone number in the text so we can easily contact you if we need more information.
Your email with all the information and photo(s) must arrive no later than June 1st.
If sending by mail:
Make checks payable to BPUSA National Gathering.
Mail to: Peggy Williams, 221 NE 3rd St., England, AR 72046
The package must be mailed in time so that we receive it no later than June 1st.2018 BPUSA NATIONAL GATHERING
SLIDESHOW PRESENTATION FORM
The slideshow presentation during the Candlelight Service is a meaningful part of our Gatherings. If you are
attending the 2018 Gathering, please send a photo of your child, (photo of your child only), via e-mail in jpg
format to bpusaweblinks@gmail.com or upload your photo on the electronic registration form. If you need to
mail a photo, send a photo no larger than 8X10 and this completed form to the address below, no later than July
1st. You can pick up your picture(s) at the Gathering Registration Table when you arrive or enclose a postage
paid addressed envelope so that your photo(s) can be immediately returned to you.
________ I have enclosed a photo of my child/children.
________ The picture should be in your file from a past Gathering.
________ Include my child’s NAME ONLY with appropriate representation (no photo available).
PRINT CLEARLY
Child/Children’s Name(s): ___________________________________________________________
Phonetic Pronunciation: ____________________________________________________________
Birth Date: _____________________________ Date of Death: ___________________________
Your Name: _____________________________________________________________________
Address: _______________________________________________________________________
City: ___________________________________________ ST: ________ Zip:______________
Phone Number:(______)_____________________ Email:_______________________________
A picture and completed form is needed for each child being remembered. The picture submitted
must be of the child only for showing during the Candlelight Service. Please put child’s name and
address on the back of the photo.
Mail to be POSTMARKED NO LATER THAN July 1, 2018
Send this form and your child’s picture to:
Matthew Groves
1190 Worthington Drive
Bridgeport, WV 26330
Upload a picture on the electronic registration or Email this form and a picture to bpusaweblinks@gmail.com,
no later than July 15th. You will receive a confirming email back. If you don’t, please follow up. You don’t want
to miss out having your child’s picture included.Memorial Template
Use this heart template to decorate in memory of
your child(ren), sibling or grandchild for decorating
our children’s memorial area during the Gathering.
Copy the heartCopy
pattern onto any color
cardstock, cut it out, and then decorate it
as you wish, adding the child’s name, their
birth and death dates, photos, phrases,
stickers, etc. on the front.
Bring your completed template with
you to the National Gathering. If you
cannot attend, mail your decorated
heart to:
Jodi Norman,
539 Harrison Circle,
Locust Grove, VA 22508
to be received no later
than July 1st.
Chapter leaders consider decorating
templates with your chapter members
during a monthly meeting before the
Gathering and bring them to the
Gathering or mail them to address
above.BPUSA Memory Walk Fundraiser
Sunday, August 5, 2018
REGISTRATION & WAIVER FORM
A separate Registration & Waiver Form must be completed and signed
by each person participating in the Memory Walk
I Am Walking In Memory Of___________________________________________
Name_______________________________________________________________________________________________________
Street Address________________________________________________________________________________________________
City, State Zip Code___________________________________________________________________________________________
Telephone_____________________ Email Address___________________________________________________
Pledge Amount*___________________________*Please make checks payable to: BPUSA
T-shirt Size___________
The Bereaved Parents of the USA, states that no goods or services were provided in exchange for your contribution. Your contribution
is tax-deductible to the extent allowed by law The Bereaved Parents of the USA, is a 501(c)3 tax-exempt not-for-profit organization.
Our employer identification number is 36-4009146.
A pledge is not required to participate in the Walk. If you cannot participate in the walk, but would like someone to walk in your child’s
memory, please print out and fill in this form and send it to Jerry Pica, 2521 Pinehurst Drive, Champaign, IL 61822 or email it to
bpusaboard2@gmail.com.
Please join us in helping BPUSA in its mission by asking family, friends and businesses to back you with pledges to support our work.
Whether you walk one mile or a hundred feet, or even make a pledge is NOT important. What matters is that you have taken the time
to join with family and friends - new and old - who are walking the same journey as you. To set up a personalized website to use for
asking for donations from family and friends, go to this site: https://www.classy.org/campaign/walk-towards-hope-and-
healing/c162565. Join your chapter’s team, create your own team or set up an individual page.
A sponsorship page is included in this packet, if you prefer to ask family and friends for donations, instead of using the website.
We would like to have all chapters participating in the Walk make a banner with the names of the children in your chapter to be carried
on the “Walk Towards Hope and Healing” at the Gathering. If you are not a member of a chapter, individuals can also make and carry
a banner or sign with your child’s name and/or picture.
Everyone who makes a donation of $30 will receive a “Walk Towards Hope and Healing” T-Shirt with your child’s picture on the back.
For a donation of $50 a sign with your child’s name and photo to be placed along the walk route, the sign will be yours to take home at
the end of the walk. Photos submitted for the slide show will be used on the t-shirts and signs.
Deadline to submit registration form in order to receive a t-shirt with picture or have a sign made is July 1, 2018.
If you have any questions about this event, please send an email to: Jerry Pica @ bpusaboard2@gmail.com or call Jerry at (217) 373-
1321.
LIABILITY WAIVER MUST BE SIGNED BEFORE PARTICIPATING IN MEMORY WALK
WAIVER AND RELEASE: I recognize that participation in the BPUSA Memory Walk may involve certain hazards. I understand that
I should not participate unless medically able. I assume all risks associated with involvement in this activity, including but not limited
to falls, contact with participants, the effects of weather, including high heat and humidity, the conditions of the track and/or road, traffic
on the course, and all risks being known and appreciated by me. Having read this waiver or release, knowing these facts and in
consideration of my acceptance into this Memory Walk, I, for myself and anyone entitled to act on my behalf, waive and release The
Bereaved Parents of the USA, and all sponsors and hosts, and their representatives and successors from all claims or liabilities of any
kind arising from involvement in this activity.
Signature (Parent or Guardian if under 18): _______________________________________________________ Date: ____________Sponsor List
We like to acknowledge all donations, so please print your name and address neatly and completely
Name and Address In Memory Of Pledge Amount
For additional information please contact : Jerry Pica @ bpusaboard2@gmail.com or call Jerry at (217) 373-1321You can also read
