WAM - Formstack

Welcome to the 2021 VIRTUAL Walk a Mile in Their Shoes! Our goal is to reach a total of 2,891 miles together (walking or running!) to represent the number of patients who received help from our SAFE/DV Program over the last five years.

This can be completed at any time between Thursday, April 1 through Saturday, April 17 at 11:59 p.m.! You can submit this form once, or multiple times letting us know how many miles you walked/ran so we can meet our goal of 2,891 miles! Share photos or videos of your walk/run on any social media platform (Facebook, Twitter, Instagram) using #GBMCWalkaMile, tagging GBMC HealthCare, or emailing socialmedia@gbmc.org so we can feature you!

All virtual participants are invited to tune in on Saturday, April 17 at 9 a.m. to watch our virtual event at www.gbmc.org/walk.

Name*

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Email*

Miles walked/run:*

Are you supporting one of our Walk a Mile Teams? Enter the team name here.

Please indicate your desired T-shirt size (S-XXL).

If you are completing this form multiple times for miles, you only need to indicate your shirt size once:

If you wish, upload a photo of yourself on, before, or after your walk/run for us to share on social media

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