Susan G. Komen Twin Cities Race for the Cure 2012 official ...Race... · Give your entry form and...
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20th Annual Susan G. Komen Twin Cities Race for the Cure ® Mother’s Day, May 13, 2012 • MALL OF AMERICA ® 2012 Official Entry *** One person per form *** First Name I___I___I___I___I___I___I___I___I___I___I___I___I Last Name I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I Male I___I Female |___I Birth Date I___I___I-I___I___I-I___I___I___I___I E-mail Address I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I Phone # I___I___I___I-I___I___I___I-I___I___I___I___I Mailing Address I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I Apt. #/ Suite I___I___I___I___I___I City I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I State I___I___I Zip Code I___I___I___I___I___I Age on Race Day I___I___I o Yes, I would like to be recognized as a breast cancer survivor by receiving a pink cap and T-shirt I___I___I # of years as a breast cancer survivor o Contact me about volunteer opportunities for 2013 TEAM INFORMATION: Teams consist of 10 or more members. The Team Captain must first create a team before team members can register for it. Team Captains must pick up ALL registered team member’s T-shirts and wristbands and distribute the materials to the members. Please note Team registration deadlines! Enter the following, ONLY if applicable: Team Name______________________________________________________Team Captain___________________________________ Registration Fees (Not refundable/transferable): Postmarked by Feb. 29: o Adults $25 o Kids (Age 12 & under)$12 Postmarked by April 21: o Adults $30 o Kids (Age 12 & under) $15 Postmarked by May 5 or in person by May 12: o Adults $35 o Kids (Age 12 & under) $17 Race Day, May 13: o Adults $40 o Kids (Age 12 & under) $20 SCHEDULE GO TO KOMENMINNESOTA.ORG OR CALL 952-746-1760 FOR MORE DETAILS! March 22: • Volunteer positions posted online (komenminnesota.org). Volunteers are vital to the success of this Race! Volunteer online or call 952-746-1760 after March 22 to sign up! April 9-May 13: • Shop for the Cure ® : kiosk in MOA ® Rotunda, 1st floor, east side May 9-10: • Team packet pick up: Noon-8PM Wednesday & Thursday: Macy’s Court, 1st floor May 11-13: • Team packet pick up: 10AM-8PM Friday & Saturday, 6-9:30AM on Race Day: Macy’s Court, 1st floor May 11-13: • Individual packet pick up: 10AM-8PM Fri-Sat, 6-9:30AM on Race Day; 1st floor, east side May 12: • Kids for the Cure ® Fun Run: 3PM; North Parking Lot, Mall of America ® • CRAVE Pre-Race Dinner: 5:30-8PM, Great Room in Nickelodeon Universe ® Sunday, May 13: • Health Expo and I AM THE CURE ® educational information: 6AM-10AM •Aerobic Warm-Up: 7AM RACE DAY! • 5K Co-Ed Wheelchair Race: 7:25AM •5K Co-Ed Run: 7:30AM •5K Walk: 9:00AM •1K Walk (inside): 9:30AM • Survivor Celebration: 11AM in MOA ® Rotunda WHERE WE’VE BEEN AND THE IMPACT WE’VE MADE TOGETHER • Nancy G. Brinker promised her dying sister, Susan G. Komen, that she would do everything in her power to end breast cancer forever. In 1982, that promise became Susan G. Komen for the Cure ® , now the world’s largest breast cancer organization and the largest source of nonprofit funds dedicated to the fight against breast cancer. Go to komen.org or call 1-877 GO KOMEN for more information. • 1993: 2307 people registered for the 1st Susan G. Komen Twin Cities Race for the Cure ® . In 2011, over 42,000 registered! • The 5 year survival rate for breast cancer, when caught early, is now 98% (compared to 74% in 1982). • 75% of our net proceeds are invested right here in Minnesota. 25% is contributed to Komen Foundation’s Award and Research Grants Program to fund ground-breaking research. To date, with more than 120 Affiliates internationally, Komen has invested nearly $1.9 billion in breast cancer research and community programs and promises to invest another $1 billion by 2017. • Susan G. Komen for the Cure has changed how the world talks about and treats breast cancer! 20 years ago, many wouldn’t even say “breast cancer” aloud. With the support of Komen Advocacy Alliance ® , the federal government now devotes more than $900 million each year to breast cancer research, treatment and prevention (compared to $30 million in 1982). • Since the first Komen Twin Cities Race for the Cure ® in 1993, the Minnnesota Affiliate has invested over $34 million to nonprofit institutions for breast cancer awareness, education, outreach, screening, preliminary treatment and research. • This year, as we celebrate our 20th Annual Race, we continue our mission and keep the Komen promise to save lives and end breast cancer forever by empowering people, ensuring quality care for all and energizing science to find the cures. REGISTER ONLINE komenminnesota.org Susan G. Komen Twin Cities Race for the Cure ® does not sell or share your registration information. Participant Signature ____________________________________________________ Date ____________ Parent or Guardian’s signature (if under 18) __________________________________ Date ____________ ***A signature is required for each participant*** PHOTO GRAPHIC AND RESULTS RELEASE and WAIVER AND RELEASE OF CLAIMS. I AGREE THAT ANY AND ALL REPRESENTATIONS MADE AND RELEASES, WAIVERS, COVENANTS, CONSENTS AND PERMISSIONS GIVEN BY ME HEREUNDER ARE GIVEN ON BEHALF OF ME AND ANY AND ALL OF MY MINOR CHILDREN OR PERSONS OVER WHOM I HAVE GUARDIANSHIP PARTICIPATING IN OR ATTENDING THE EVENT. I give my consent and permission to The Susan G. Komen Breast Cancer Foundation, Inc. d/b/a Susan G. Komen for the Cure (“Komen”), its affiliates and races, their sponsors and corporate sponsors, their successors, licensees, and assigns the irrevocable right to use, for any purpose whatsoever and without compensation, (i) any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of this event (the “Event”); and (ii) the results of my participation in this Event (e.g., race time, name, participant number). I understand that (i) my consent to these provisions is given in consideration for being permitted to participate in this Event; (ii) I may be removed from this competition if I do not follow all the rules of this Event; (iii) I am a voluntary participant in this Event. I am in good physical condition and am solely responsible for my personal health, safety and personal property. I KNOW THAT THIS EVENT IS A POTENTIALLY HAZARDOUS ACTIVITY AND I HEREBY VOLUNTARILY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR, AND THE RISK OF, ANY INJURY OR ACCIDENT WH ICH MAY OCCUR DURING MY PARTICIPATION IN THIS EVENT (INCLUDING, BUT NOT LIMITED TO, MY FUNDRAISING ACTIVITIES associated with the event) OR WHILE ON THE EVENT PREMISES (COLLECTIVELY, “MY PARTICIPATION”). TO THE FULLEST EXTENT OF THE LAW, I, FOR MYSELF, MY NEXT OF KIN, MY HEIRS, ADMINISTRATORS, AND EXECUTORS (COLLECTIVELY, “RELEASORS”), HEREBY RELEASE AND HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST (I) KOMEN, THE MINNESOTA AFFILIATE OF THE SUSAN G. KOMEN BREAST CANCER FOUNDATION D/B/A THE MINNESOTA AFFILIATE OF SUSAN G. KOMEN FOR THE CURE, AND ALL OTHER KOMEN AFFILIATES AND THEIR RESPECTIVE DIRECTORS, OFFICERS, VOLUNTEERS, AGENTS AND EMPLOYEES; THE CITY OF BLOOMINGTON AND PORT AUTHORITY OF THE CITY OF BLOOMINGTON, MINNESOTA, MALL OF AMERICA, MOAC MALL HOLDINGS LLC; MOA ENTERTAINMENT COMPANY LLC; MOA MANAGEMENT LLC AND MOA MARKETING, INC., AND THEIR RELATED ENTITIES, DIRECTORS, PARTNERS, MEMBERS, SHAREHOLDERS, EMPLOYEES, CONTRACTORS, AGENTS, SUCCESSORS, AND ASSIGNS, AND ALL OTHER PERSONS, FIRMS, CORPORATIONS, ASSOCIATIONS, PARTNERSHIPS, TRUSTS, LIMITED LIABILITY COMPANIES, EMPLOYERS, AND THEIR RESPECTIVE SUCCESSORS, HEIRS, EXECUTORS, ADMINISTRATORS, TRUSTS, EMPLOYERS, AGENTS, SUCCESSORS, AND ASSIGNS LIABLE OR WHO MIGHT BE CLAIMED TO BE LIABLE; (II) ANY EVENT SPONSORS; AND (III) ALL OTHER PERSONS OR ENTITIES ASSOCIATED WITH THIS EVENT (COLLECTIVELY, THE “RELEASEES”) FOR ANY INJURY OR DAMAGES I MIGHT SUFFER IN CONNECTION WITH MY PARTICIPATION. THIS RELEASE APPLIES TO ANY AND ALL LOSS, LIABILITY, OR CLAIMS I OR MY RELEASORS MAY HAVE ARISING OUT OF MY PARTICIPATION, INCLUDING BUT NOT LIMITED TO, PERSONAL INJURY OR DAMAGE SUFFERED BY ME OR OTHERS, WHETHER SUCH LOSSES, LIABILITIES, OR CLAIMS BE CAUSED BY FALLS, CONTACT WITH AND/OR THE ACTIONS OF OTHER PARTICIPANTS, CONTACT WITH FIXED OR NON-FIXED OBJECTS, CONTACT WITH ANIMALS, CONDITIONS OF THE EVENT PREMISES, NEGLIGENCE OF THE RELEASEES, RISKS NOT KNOWN TO ME OR NOT REASONABLY FORESEEABLE AT THIS TIME, OR OTHERWISE. I understand that I am solely responsible and liable for all aspects of MY fundraising activities associated with my participation, including, but not limited to, the safe and lawful conduct of any fundraising activities. This Photographic Release and Results and Waiver and Release of Claims (collectively, the “Release”) shall be construed under the laws of the state in which the Event is held. In the event any provision of this Release is deemed unenforceable by law, (i) Komen shall have the right to modify such provision to the extent necessary to be deemed enforceable; and (ii) all other provisions of this Release shall remain in full force and effect. I understand that I have given up substantial rights by signing this Release, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of liability to the greatest extent allowed by law. Your Registration Fee gets you to the Start Line; your fundraising gets us to the Finish Line! Participate in the Friends for the Cure ® program. Not only will your donations make an amazing impact, you’ll be eligible to receive fabulous prizes for any individual fundraising of $100 or more too! If you raise $1000 or more on your personal fundraising page, you’ll be recognized as a Pink Honor Roll member with a special reward and celebratory event! Download a donation form, check out the prizes and eligibility, and learn more about the Pink Honor Roll at komenminnesota.org or call 952-746-1760. INDIVIDUAL REGISTRANTS (NOT ON A TEAM) Mail completed entry form and entry fee to: Susan G. Komen Twin Cities Race for the Cure P.O. Box 312 Lake Elmo, MN 55042-0312 TEAM MEMBERS Give your entry form and payment to your Team Captain. TEAM CAPTAINS Mail all member’s registration forms together by April 21, 2012 to: Susan G. Komen Twin Cities Race for the Cure Mall of America 301 South Avenue Bloomington, MN 55425 REGISTER IN PERSON (NON TEAM MEMBERS) April 9th-May 10, 2012: 10AM-8PM at our Shop for the Cure ® kiosk in MOA ® Rotunda Race weekend: May 11 & 12 between 10AM-8PM Race Day: May 13th, from 6AM to 9:30AM. DEADLINES ONLINE MAIL IN PERSON Individual Registration May 8, 10PM CST Postmark, May 5 May 13 (in MOA ® Rotunda) Creating a Team April 21, 10PM CST Postmark, April 21 April 21 (in MOA ® Rotunda) Joining a Team April 30, 10PM CST Postmark, April 21 April 21 (in MOA ® Rotunda) Friends for the Cure ® donations June 22, 10PM CST Postmark, June 22 May 13 (in MOA ® Rotunda) CRAVE Pre-Race Dinner: I___I # Adults attending ($12 each) I___I # Children attending ($6 each) TOTAL YOUR PAYMENT: DINNER AMOUNT $ _________ + REGISTRATION FEE $ _________ + DONATION* AMOUNT $ _________ = TOTAL PAYMENT $ _______________ CORPORATE MATCHING GIFTS: If your company has a matching gift program, you can double your donation. Go to komenminnesota.org for more information. *Make my additional donation o In Memory of o In Honor of: __________________________________ Please send a notice of this donation to: ____________________________________________________ Address ______________________________________________________________________________ City ______________________________________________________ State ______ Zip _____________ Payment Method (please mark one): o Check (payable to: Komen Twin Cities Race for the Cure ® ) o Cash o VISA o MasterCard o AM Express Account # I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I Exp. Date I___I___I-I___I___I Signature ___________________________________________________________________________ Event (check one): o 5K Walk o 5K Co-Ed Run o 1K Walk o 5K Wheelchair Race o Kid’s Fun Run o Sleep in for the Cure ® Will you consider an additional tax deductible $20 donation in honor of our 20th annual Komen Twin Cities Race for the Cure ® ? PLEASE NOTE: *This is considered a General donation and not applied to team or individual fundraising pages. Please submit those Friends for the Cure ® donations separately with a Friends for the Cure donation form to ensure proper credit is given. T-shirt Size (check one): o Adult S o Adult M o Adult L o Adult XL o Adult XXL o Youth XS (2-4) o Youth S (6-8) o Youth M (10-12) o Youth L (14-16)
Transcript of Susan G. Komen Twin Cities Race for the Cure 2012 official ...Race... · Give your entry form and...
20th Annual Susan G. Komen Twin Cities Race for the Cure® Mother’s Day, May 13, 2012 • MAll of AMeRiCA® 2012 official entry *** one person per form ***
First Name I___I___I___I___I___I___I___I___I___I___I___I___I Last Name I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I
Male I___I Female |___I Birth Date I___I___I-I___I___I-I___I___I___I___I
E-mail Address I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I Phone # I___I___I___I-I___I___I___I-I___I___I___I___I
Mailing Address I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I Apt. #/ Suite I___I___I___I___I___I
City I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I State I___I___I Zip Code I___I___I___I___I___I Age on Race Day I___I___I
o Yes, I would like to be recognized as a breast cancer survivor by receiving a pink cap and T-shirt I___I___I # of years as a breast cancer survivor
o Contact me about volunteer opportunities for 2013
TeAM iNfoRMATioN: Teams consist of 10 or more members. The Team Captain must first create a team before team members can register for it. Team Captains must pick up ALL registered team member’s T-shirts and wristbands and distribute the materials to the members. Please note Team registration deadlines!
enter the following, oNlY if applicable: Team Name______________________________________________________Team Captain___________________________________
Registration fees (Not refundable/transferable):Postmarked by feb. 29:
o Adults $25 o Kids (Age 12 & under)$12
Postmarked by April 21:
o Adults $30 o Kids (Age 12 & under) $15
Postmarked by May 5 or in person by May 12:
o Adults $35 o Kids (Age 12 & under) $17
Race Day, May 13:
o Adults $40 o Kids (Age 12 & under) $20
SCheDule Go To KoMeNMiNNeSoTA.oRG oR CAll 952-746-1760 foR MoRe DeTAilS! March 22: • Volunteer positions posted online (komenminnesota.org). Volunteers are vital to the success of this Race! Volunteer online or call 952-746-1760 after March 22 to sign up!April 9-May 13: • Shop for the Cure®: kiosk in MOA® Rotunda, 1st floor, east sideMay 9-10: • Team packet pick up: Noon-8PM Wednesday & Thursday: Macy’s Court, 1st floorMay 11-13: • Team packet pick up: 10AM-8PM Friday & Saturday, 6-9:30AM on Race Day: Macy’s Court, 1st floor May 11-13: • Individual packet pick up: 10AM-8PM Fri-Sat, 6-9:30AM on Race Day; 1st floor, east sideMay 12: • Kids for the Cure® Fun Run: 3PM; North Parking Lot, Mall of America®
• CRAVE Pre-Race Dinner: 5:30-8PM, Great Room in Nickelodeon Universe®
Sunday, May 13: • Health Expo and I AM THE CURE® educational information: 6AM-10AM •Aerobic Warm-Up: 7AMRACe DAY! • 5K Co-Ed Wheelchair Race: 7:25AM •5K Co-Ed Run: 7:30AM •5K Walk: 9:00AM •1K Walk (inside): 9:30AM • Survivor Celebration: 11AM in MOA® Rotunda
WheRe We’ve beeN AND The iMPACT We’ve MADe ToGeTheR• Nancy G. Brinker promised her dying sister, Susan G. Komen, that she would do everything in her power to end breast cancer forever. In 1982, that promise became Susan G. Komen for the Cure®, now the world’s largest breast cancer organization and the largest source of nonprofit funds dedicated to the fight against breast cancer. Go to komen.org or call 1-877 GO KOMEN for more information.• 1993: 2307 people registered for the 1st Susan G. Komen Twin Cities Race for the Cure®. In 2011, over 42,000 registered! • The 5 year survival rate for breast cancer, when caught early, is now 98% (compared to 74% in 1982).• 75% of our net proceeds are invested right here in Minnesota. 25% is contributed to Komen Foundation’s Award and Research Grants Program to fund ground-breaking research. To date, with more than 120 Affiliates internationally, Komen has invested nearly $1.9 billion in breast cancer research and community programs and promises to invest another $1 billion by 2017.• Susan G. Komen for the Cure has changed how the world talks about and treats breast cancer! 20 years ago, many wouldn’t even say “breast cancer” aloud. With the support of Komen Advocacy Alliance®, the federal government now devotes more than $900 million each year to breast cancer research, treatment and prevention (compared to $30 million in 1982). • Since the first Komen Twin Cities Race for the Cure® in 1993, the Minnnesota Affiliate has invested over $34 million to nonprofit institutions for breast cancer awareness, education, outreach, screening, preliminary treatment and research.• This year, as we celebrate our 20th Annual Race, we continue our mission and keep the Komen promise to save lives and end breast cancer forever by empowering people, ensuring quality care for all and energizing science to find the cures.
ReGiSTeR oNliNe komenminnesota.orgSusan G. Komen Twin Cities Race for the Cure® does not sell or share your registration information.
Participant Signature ____________________________________________________ Date ____________
Parent or Guardian’s signature (if under 18) __________________________________ Date ____________
***A signature is required for each participant***
PhoTo GRAPhiC AND ReSulTS ReleASe and WAiveR AND ReleASe of ClAiMS. i AGRee ThAT ANY AND All RePReSeNTATioNS MADe AND ReleASeS, WAiveRS, CoveNANTS, CoNSeNTS AND PeRMiSSioNS GiveN bY Me heReuNDeR ARe GiveN oN behAlf of Me AND ANY AND All of MY MiNoR ChilDReN oR PeRSoNS oveR WhoM i hAve GuARDiANShiP PARTiCiPATiNG iN oR ATTeNDiNG The eveNT. I give my consent and permission to The Susan G. Komen Breast Cancer Foundation, Inc. d/b/a Susan G. Komen for the Cure (“Komen”), its affiliates and races, their sponsors and corporate sponsors, their successors, licensees, and assigns the irrevocable right to use, for any purpose whatsoever and without compensation, (i) any photographs, videotapes, audiotapes, or other recordings of me that are made during the course of this event (the “Event”); and (ii) the results of my participation in this Event (e.g., race time, name, participant number). I understand that (i) my consent to these provisions is given in consideration for being permitted to participate in this Event; (ii) I may be removed from this competition if I do not follow all the rules of this Event; (iii) I am a voluntary participant in this Event. I am in good physical condition and am solely responsible for my personal health, safety and personal property. I KNOW THAT THIS EVENT IS A POTENTIALLY HAZARDOUS ACTIVITY AND I HEREBY VOLUNTARILY ASSUME FULL AND COMPLETE RESPONSIBILITY FOR, AND THE RISK OF, ANY INJURY OR ACCIDENT WH ICH MAY OCCUR DURING MY PARTICIPATION IN THIS EVENT (INCLUDING, BUT NOT LIMITED TO, MY FUNDRAISING ACTIVITIES associated with the event) OR WHILE ON THE EVENT PREMISES (COLLECTIVELY, “MY PARTICIPATION”). TO THE FULLEST EXTENT OF THE LAW, I, FOR MYSELF, MY NEXT OF KIN, MY HEIRS, ADMINISTRATORS, AND EXECUTORS (COLLECTIVELY, “RELEASORS”), HEREBY RELEASE AND HOLD HARMLESS AND COVENANT NOT TO FILE SUIT AGAINST (I) KOMEN, THE MINNESOTA AFFILIATE OF THE SUSAN G. KOMEN BREAST CANCER FOUNDATION D/B/A THE MINNESOTA AFFILIATE OF SUSAN G. KOMEN FOR THE CURE, AND ALL OTHER KOMEN AFFILIATES AND THEIR RESPECTIVE DIRECTORS, OFFICERS, VOLUNTEERS, AGENTS AND EMPLOYEES; THE CITY OF BLOOMINGTON AND PORT AUTHORITY OF THE CITY OF BLOOMINGTON, MINNESOTA, MALL OF AMERICA, MOAC MALL HOLDINGS LLC; MOA ENTERTAINMENT COMPANY LLC; MOA MANAGEMENT LLC AND MOA MARKETING, INC., AND THEIR RELATED ENTITIES, DIRECTORS, PARTNERS, MEMBERS, SHAREHOLDERS, EMPLOYEES, CONTRACTORS, AGENTS, SUCCESSORS, AND ASSIGNS, AND ALL OTHER PERSONS, FIRMS, CORPORATIONS, ASSOCIATIONS, PARTNERSHIPS, TRUSTS, LIMITED LIABILITY COMPANIES, EMPLOYERS, AND THEIR RESPECTIVE SUCCESSORS, HEIRS, EXECUTORS, ADMINISTRATORS, TRUSTS, EMPLOYERS, AGENTS, SUCCESSORS, AND ASSIGNS LIABLE OR WHO MIGHT BE CLAIMED TO BE LIABLE; (II) ANY EVENT SPONSORS; AND (III) ALL OTHER PERSONS OR ENTITIES ASSOCIATED WITH THIS EVENT (COLLECTIVELY, THE “RELEASEES”) FOR ANY INJURY OR DAMAGES I MIGHT SUFFER IN CONNECTION WITH MY PARTICIPATION. THIS RELEASE APPLIES TO ANY AND ALL LOSS, LIABILITY, OR CLAIMS I OR MY RELEASORS MAY HAVE ARISING OUT OF MY PARTICIPATION, INCLUDING BUT NOT LIMITED TO, PERSONAL INJURY OR DAMAGE SUFFERED BY ME OR OTHERS, WHETHER SUCH LOSSES, LIABILITIES, OR CLAIMS BE CAUSED BY FALLS, CONTACT WITH AND/OR THE ACTIONS OF OTHER PARTICIPANTS, CONTACT WITH FIXED OR NON-FIXED OBJECTS, CONTACT WITH ANIMALS, CONDITIONS OF THE EVENT PREMISES, NEGLIGENCE OF THE RELEASEES, RISKS NOT KNOWN TO ME OR NOT REASONABLY FORESEEABLE AT THIS TIME, OR OTHERWISE. I understand that I am solely responsible and liable for all aspects of MY fundraising activities associated with my participation, including, but not limited to, the safe and lawful conduct of any fundraising activities. This Photographic Release and Results and Waiver and Release of Claims (collectively, the “Release”) shall be construed under the laws of the state in which the Event is held. In the event any provision of this Release is deemed unenforceable by law, (i) Komen shall have the right to modify such provision to the extent necessary to be deemed enforceable; and (ii) all other provisions of this Release shall remain in full force and effect. I understand that I have given up substantial rights by signing this Release, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of liability to the greatest extent allowed by law.
Your Registration fee gets you to the Start line; your fundraising gets us to the finish line! Participate in the friends for the Cure® program. Not only will your donations make an amazing impact, you’ll be eligible to receive fabulous prizes for any individual fundraising of $100 or more too! if you raise $1000 or more on your personal fundraising page, you’ll be recognized as a Pink honor Roll member with a special reward and celebratory event! Download a donation form, check out the prizes and eligibility, and learn more about the Pink honor Roll at komenminnesota.org or call 952-746-1760.
iNDiviDuAl ReGiSTRANTS (NoT oN A TeAM)Mail completed entry form and entry fee to:Susan G. Komen Twin Cities Race for the CureP.O. Box 312Lake Elmo, MN 55042-0312
TeAM MeMbeRSGive your entry form and payment to your Team Captain.TeAM CAPTAiNSMail all member’s registration forms together by April 21, 2012 to:Susan G. Komen Twin Cities Race for the CureMall of America301 South AvenueBloomington, MN 55425
ReGiSTeR iN PeRSoN (NoN TeAM MeMbeRS)April 9th-May 10, 2012: 10AM-8PM at our Shop for the Cure® kiosk in MOA® RotundaRace weekend: May 11 & 12 between 10AM-8PM Race Day: May 13th, from 6AM to 9:30AM.
DeADliNeS oNliNe MAil iN PeRSoNIndividual Registration May 8, 10PM CST Postmark, May 5 May 13 (in MOA® Rotunda)Creating a Team April 21, 10PM CST Postmark, April 21 April 21 (in MOA® Rotunda) Joining a Team April 30, 10PM CST Postmark, April 21 April 21 (in MOA® Rotunda)Friends for the Cure® donations June 22, 10PM CST Postmark, June 22 May 13 (in MOA® Rotunda)
CRAve Pre-Race Dinner:
I___I # Adults attending ($12 each)
I___I # Children attending ($6 each)
ToTAl YouR PAYMeNT: DiNNeR AMouNT $ _________ + ReGiSTRATioN fee $ _________ + DoNATioN* AMouNT $ _________ = ToTAl PAYMeNT $ _______________
CoRPoRATe MATChiNG GifTS: If your company has a matching gift program, you can double your donation. Go to komenminnesota.org for more information.
*Make my additional donation o in Memory of o in honor of: __________________________________
Please send a notice of this donation to: ____________________________________________________
Address ______________________________________________________________________________
City ______________________________________________________ State ______ Zip _____________
Payment Method (please mark one): o Check (payable to: Komen Twin Cities Race for the Cure®) o Cash
o VISA o MasterCard o AM Express
Account # I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I
Exp. Date I___I___I-I___I___I
Signature ___________________________________________________________________________
event (check one):
o 5K Walk o 5K Co-Ed Run
o 1K Walk
o 5K Wheelchair Race
o Kid’s Fun Run
o Sleep in for the Cure®
Will you consider an additional tax deductible $20 donation in honor of our 20th annual Komen Twin Cities Race for the Cure®? PLEASE NOTE: *This is considered a General donation and not applied to team or individual fundraising pages. Please submit those Friends for the Cure® donations separately with a Friends for the Cure donation form to ensure proper credit is given.
T-shirt Size (check one):
o Adult S
o Adult M
o Adult L
o Adult XL
o Adult XXL
o Youth XS (2-4)
o Youth S (6-8)
o Youth M (10-12)
o Youth L (14-16)
MAKiNG AN iMPACT iN MiNNeSoTA foR
20 YeARS!
ThiS bRoChuRe CouRTeSY of &KDKdesign
iMPoRTANT ReMiNDeRS:• All event attendees MuST be registered, regardless of age. Remember, registration fees help us on our mission.
• Register by February 29th to enjoy early bird rates and get a jump start on your fundraising!
• Participant wristbands MUST be worn to fully participate in Race activities and enter the new, expanded Health Expo area.
• Your entry fee includes a Susan G. Komen Twin Cities Race for the Cure® T-shirt, Race bib, wristband, and Race Day refreshments. Any donation or fundraising above and beyond your entry fee is considered tax deductible!
• Fundraising rewards are better than ever! Go to komenminnesota.org to see how you’ll be rewarded for making an IMPACT.
• If you raise $1000 or more on your personal fundraising page, you’ll enjoy the benefits of being a Pink Honor Roll member and be eligible for an American Airlines ticket!
• This event will occur rain or shine. We reserve the right to cancel in extreme circumstances. In that event, there will be no refunds and your entry fee will be used as a donation to Susan G. Komen Twin Cities Race for the Cure®.
• For the safety of all participants, rollerblades and pets are not allowed in this event. Thank you for your cooperation.
• Baby joggers and strollers are not allowed in the Co-Ed 5K run.
• Race Day parking: MOA® has plenty of parking. However, carpooling and mass transit are encouraged.
• Race Results: Results will be posted exclusively at komenminnesota.org after 5PM on Race Day.
• 5K Race course USATF certification number: MN-06008-RR
Fastsigns of Minnetonka and Eden PrairieVirginia Piper Cancer Institute® of Allina Health
Mike habermann Photography
for additional entry forms, please call 952-746-1760
hoNoRARY ChAiRS
iNveSTiNG WiTh CoNfiDeNCeSusan G. Komen for the Cure® has received Charity Navigator’s highest rating of four stars. No matter what level of support you give Komen Twin Cities Race for the Cure®, you can do so with confidence in the impact your investment will have on ending breast cancer!
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ReGiSTeR oNliNe! Save the environment by helping pink go green! Register at komenminnesota.org.
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2012 SUSAN G. KOMEN TWIN CITIES RACE FOR THE CURE®
ReGiSTeR ToDAY!
MoTheR’S DAYSuNDAY, MAY 13, 2012
LOCAL PRESENTING SPONSORS:
A MoTheR’S DAY TRADiTioN SiNCe 1993!
NeW! Register by february 29th and enjoy early
bird rates! Go to komenminnesota.org for details!
The Running Ribbon is a registered trademark of Susan G. Komen for the Cure®.
HOST SITE:
