Mental Health Awareness Campaign: 'Check Up from the Neck Up': Registration Form rev

Event Registration

Wellness Fridays is a community-centered event series that brings together mental health awareness, healing practices, and accessible wellness education—designed especially for BIPOC and underserved communities. Whether you're looking to unwind, learn new self-care strategies, or connect with wellness providers in your area, this is your space to breathe, grow, and heal—together.
Event Schedule

5:30 – 6:45 PM | Vendor Tables & Community Networking
Explore offerings from local wellness businesses, nonprofit organizations, and service providers.

7:00 – 8:30 PM | Breakout Dialogues Series & Wellness IWorkshops
Join interactive sessions, including yoga, Reiki, journaling, cooking demos, and mental health discussions.

This event will support several key initiatives, including:
- Raising Awareness of Mental Health Services: Highlighting the importance of mental health and providing information on available services within our community.
- Promoting Self-Care and Wellness: Educating attendees on the benefits of self-care practices and wellness routines.
- Supporting Local Businesses: Offering a platform for local businesses to connect, collaborate, and thrive.
Date

MonthDayYear
Date
Who is completing this form?*

I am a General AttendeeI am a Sponsor/PartnerI am a Vendor/ExhibitorI am a VolunteerOther
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Business Name:
Select your contribution(s)*
prevnext( X )
Nourishment ContributionHelps provide light refreshments, water, and snacks for attendees and guests. Includes: Recognition on signage near refreshment tables, Logo/Name on digital & print marketing, Verbal acknowledgment during events, and complimentary event passes
$1,500.00



Speaker & Program ContributorHelps cover honorariums for local speakers, facilitators, and workshop leaders. Includes: Logo/Name listed in workshop schedule & flyers, Recognition on social media and email blasts, Invitation to private partner appreciation event, complimentary event passes
$1,000.00



Marketing & Outreach ContributorSupports design, printing, and promotion efforts to help us reach diverse audiences. Includes: Name/logo featured on flyers, posters, social media, and digital promotions, Shout-out on campaign platforms, and complimentary event pass.
$500.00



Community CaregiverSupports overall event logistics like set-up materials, volunteer meals, and accessibility accommodations. Includes: Recognition in event recap email & social media, Invitation to attend as a guest
$250.00



Community Sponsor TicketIncludes entry to all Wellness Fridays and supports community access to mental health and wellness resources.
$100.00 Quantity



Indvidual ticket holderInclude one (1) ticket as an attendee
$25.00 Quantity



Equity TicketA reduced-rate ticket to ensure access for underserved and marginalized community members.
$10.00 Quantity



Vendors (Tabling)Showcase your wellness services, products, or resources
$25.00 Quantity



Health Care Provider/VolunteerProvide health screenings, resources, or wellness education to help community members access preventative care and support.
$ Free Quantity



Total

$0.00
Which dates will you attend?*

Friday, May 2, 2025Friday, May 16, 2025Friday, May 23, 2025
Will you be providing samples, giveaways, or demos?

YesNo
Brief Description of Business Products/Services:
(For Vendors/Exhibitors)
💬 How Did You Hear About This Event?

Social MediaWord of MouthEmailPartner OrganizationOther
Sponsor & Vendor Logo Upload

Cancelof
Signature

Clear
Consent & Agreement*

I agree to terms & conditions.I acknowledge that photography and video may be taken at the event for promotional purposes.I understand that registration is not confirmed until payment is received (if applicable).I understand that registration is not confirmed until payment is received (if applicable).
Please Note: Proceeds from this event will support Our Village Services’ community programs, including the Breaking Barriers Fund and the School-Based Suspension Diversion Program.
A portion of the funds will also help cover guest speakers and light refreshments provided during each session. Your participation directly helps us invest in community healing and equity.
Our Village Services, LLC - 1st Step Counseling PLLC

1525 Western Ave, Ste 4, Albany, NY 12203

www.ourvillageservices.com

info@1ststepcounselingny.com

(518) 629-5409
Should be Empty:

Event Registration