PARKING DO NOT USE MAIN GATE Use Parsonage Street entrance. Travel south, past main gate, to Platt Avenue. It is south of the fairgrounds’ chain-link fence. If you’re traveling south on Rte.9 it’s the first left after the Northern Dutchess Hospital; if you’re traveling north on Rte. 9, it’s the right turn after the spa. Stay on Platt Ave, all the way to the end. Make a LEFT onto Parsonage Street. Go 250 feet to the fairgrounds. At the stop sign make the LEFT turn.

Note: From Route 9, Parsonage Street is only 2 blocks

VENDORS: Please review our guidelines which are posted on our website www.autismwalkhv.org. Tables and chairs will be provided, please do not

bring your own.

SAVE THE DATE

NO PETS, PLEASE! NO BICYCLES, SCOOTERS, ROLLERBLADES, SKATEBOARDS, ETC. CHILDREN UNDER 12, AS WELL AS INDIVIDUALS WITH DISABILITIES, MUST BE ACCOMPANIED BY AN ADULT AT ALL TIMES.

PRE-REGISTRATION FORM Please Print

Name Address City State Zip Phone

Please feel free to copy and distribute the form

Pre-Registration forms MUST BE POSTMARKED NO LATER THAN April 12, 2016! Or bring it with you to the event.

Waiver and Release of Liability : I hereby waive all claims against Hudson Valley Autism Soci-ety (HVAS)/Autism Expo, sponsors, and personnel, or any volunteers for any injury I may suffer in this event. I attest that I am physically fit and prepared for this event. I grant full permission for organizers to use photographs of me and quotations from me in legitimate accounts and promotions of this event. Signature

(Parent or Guardian must sign if walker is under 18 years old)

My employer has a MATCHING GIFT program:

Yes No

Phone_________________________________________

Email _________________________________________

I will be walking as a member of ____________team or ___as an individual

Please make checks or money orders payable to:

Hudson Valley Autism Awareness 1E Surrey Lane

Wappingers Falls, NY 12590

2016 SPONSORS

To become a member of our chapter go to: www.autismsociety.org/chapter512

FOR SAFETY PURPOSES:

March 25, 2016 Vine Van Gogh - Sip & Paint Port Ewen Firehouse HQ tickets: vinevangogh.com

April 16, 2016 Lift for Autism 4 - Hudson Valley Strength

Pop's Pavilion - Wallkill, NY Call Nick Engels 845-750-0146

May 12, 2016 Autism Insurance Workshop Northern Dutchess Hospital call ASA-HV: 845-331-2626

May 14, 2016 Autism Tomorrow Conference

Author Ron Suskind - "Life Animated" Anderson Center for Autism Campus

register: www.andersoncenterforautism.org/autismtomorrow

July 15, 2016 Hudson Valley Renegades Funderaiser

Dutchess Stadium tickets online: GadesGroups.com PW: ASHV

July 30, 2016 Insane 5K—Team Autism

Dutchess County Fairgrounds Call: ASA-HV for more information 845-331-2626

Date To Be Determined Autism Family Fun Day

Details to be distributed on Facebook & Website

November 4, 2016 Sensory Smart Strategies for Real-Life Challenges

Lindsey Biel - OTR/L Poughkeepsie Grand Hotel register at: adshelps.org

Rhinebeck

Fire Dept.

The Walk & Expo takes place at the track area of the

fairgrounds. It is a 1 - 2 mile walk on the track.

Persons with Special Needs

WAIVED

Juniors (11-17)

Children (10 & Under)

Not-for-Profit Table

For Profit Table

Total Pledge & Registration

FEE QTY TOTAL

Adults $ 10

$ 5

WAIVED

$60… if selling merchandise; $35 if “Info Only”

$ 125 *

Other Donations

Cut and mail only this panel to pre-register

NOW ACCEPTING PAYPAL DONATIONS AT:

WWW.AUTISMWALKHV.ORG

AUTISM WALK & EXPO

OF THE

HUDSON VALLEY AT THE DUTCHESS COUNTY FAIRGROUNDS

Route 9 ~ Rhinebeck, NY

Sunday, April 24, 2016

INFO ABOUT AUTISM SPECTRUM DISORDER (ALSO KNOWN AS ASD)

****************************************************

• It is a neurological disorder impacting brain function and normal brain development.

• Persons with ASD struggle with social interaction and communication.

• The Autism Society of America estimates that every day 60 children in the U.S. are diagnosed with a form of autism.

• 1 in every 68 children (1 in every 42 boys) born today are diagnosed with a form of ASD.

REASONS TO SUPPORT THE WALK:

• To help build awareness of ASD. • To continue to fund Community Respite, Recreation, Education Programs, and Research -- right here in the Hudson Valley. • To have a family fun day!

Together, we can make a difference!

Autism

Walk & Expo of The Hudson Valley

1E Surrey Lane

Wappingers Falls, N

Y 12590

Pre

so

rted

Fir

st

Cla

ss

US

Po

sta

ge P

aid

N

ew

bu

rgh

, N

Y

Perm

it #

8604

Please Help the Autism

Community of the Hudson Valley Region www.autism

walkhv.org

PLEASE HELP SOMEONE WITH AUTISM

Event Time: 9:00 am to 1:00 pm Registration Begins at 8:30 am Opening Ceremonies: 10:00 am

Walk begins at 10:30 am *Rain or Shine* Track Area

Information & Fun Fair Games & Activities for Youngsters

(845) 331-2626 www.autismwalkhv.org

ADDRESS SERVICE REQUESTED

1 2 3 4 5 6 7 8 9 10

$ $ $ $ $ $ $ $ $ $

PLEASE USE A SEPARATE SHEET OF PAPER FOR ADDITIO

NAL SPONSORS - THANK YOU

Sponsors’ Nam

e

Address

Amount Donated