The Sharon Campisi Memorial Grant by Links des Pink
Links des Pink is excited about naming their new Grant program after someone who was so strong & such an advocate, Sharon Campisi. Her memory will be carried on to help others. If you want to nominate someone please download the 3 page form and submit by mail, fax or email..
Sharon Campisi Memorial Grant
by Links des Pink Cancer Awareness Organization
P O Box 124 Abbeville, La. 70511
Phone #337-247-7465 Fax #866-770-8755
LinksdesPink@gmail.com website – LinksdesPink.org
LDP Grant Nomination Form
Date ___________
Nominee Name ____________________________
Address __________________________________
Phone # _______________ Type of Cancer____________
Please share with us how Cancer has affected this
nominee and their family
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Nominated by ______________ Phone # ___________ Date ________
Office use only:Voter Name Accepted/Declined Date
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Resolution ________________ Date____________
Links des Pink
Disclaimer, Waver of Claims and Release of Liability
Disclaimer: Links des Pink disclaims any and all liability for any unauthorized or inappropriate use of money or equipment furnished by Links des Pink that may result in any physical injury or bodily harm.
Waiver: It is expressly agreed and understood that all use of Links des Pink services, programs and equipment shall be undertaken by the undersigned at his/her sole risk. Links des Pink shall not be liable for any injuries or damage whatsoever to the undersigned or for any injury or damage to any property of the undersigned. Also, Links de Pink shall not be subject to any claim, demand, injury or damages whatsoever, including without limitation, those damages resulting from acts of active or passive negligence on the part of Links des Pink, its officers, volunteers or agents, or anyone using Links des Pink facility or equipment. The undersigned, for himself/herself and on behalf of his/her executors, administrators, heirs, personal representatives, successors and assigns, does hereby expressly forever release and discharge Links des Pink , its officers, volunteers associates, agents, instructors, assignees and successors from all claims, demands, injuries, damages, actions or causes of action in any manner related to the use of Links des Pink facility, equipment, premises or funds.
I understand the participation in Links des Pink programs is voluntary and no Links des Pink volunteer, employee, board of directors or officer convinced, coerced or forced me to participate in this program or accepting funds.
I have made the decision to partidipate with full knowledge of my medical history and current medical status and therefore, hold Links des Pink harmless from any injury, advancement of illness, or death from participation in any program offered by Links des Pink, including receiving funds.
I understand that any injuries resulting from participation will not be considered the fault of Links des Pink, its volunteers, employees, board of directors or officers and are my responsibility.
I further indemnify and hold harmless Links des Pink and its volunteers, employees, board of directors or officers from any and all claims, actions, demands, costs, liabilities, expenses and judgements whatsoever including reasonable attorney fees and costs which might arise in any manner from my participation in any Links des Pink programs.
Links des Pink shall not be responsible or liable to the undersigned for any articles lost, damaged, or stolen in or about areas where Links des Pink is/was doing business or participating in activities, adjoining premises or parking lot, for loss or damage to any property, including but not limited to automobile and the contents thereof that may be left anywhere on the premises. By his/her signature below, the undersigned hereby agrees to follow all of the rules of Links des Pink in use of their facility, programs and equipment.
AGREED and ACKNOWLEDGED by the undersigned for and in consideration of the Links des Pink programs, facilities and equipment this _____day of _____________ 20______ effective until released and returned by Links des Pink.
SIGNATURE ____________________________________________
PRINT NAME ___________________________________________
WITNESS ______________________________________________
Links des Pink Breast Cancer Awareness Inc. is an organization dedicated to providing awareness education, research and care about Breast Cancer and other cancers to our Neighbors, Friends & Family. Links des Pink does not discriminate against any person because of their race, creed, religion, gender or age.