Adult: $20.00 Youth: $15.00 Name: ______________________________Age_____ Name: ______________________________Age_____ Name: ______________________________Age_____ Name: ______________________________Age_____ Address: ____________________________________ Community Breast Care Project 2854 S. Ten Mile Drive Jefferson City, MO 65109 REGISTRATION REQUIRED City:____________________State____ Zip: ______ Email: ______________________________________ ____________________________________________ Shirt Sizes Needed: (circle one for each reg.) Adult S M L XL XXL Youth S M L XL Event: Circle One Women’s Run Men’s 5K Fun Run Women’s Walk Each registrant will receive a t-shirt the day of the race provided you have pre-registered. Make checks payable to CBCP and mail to: CBCP, 2854 S. Ten Mile Drive, Jefferson City, MO 65109 More information and online registration is available at www.communitybreastcareproject.org 5K Walk/Run Saturday, May 9, 2015 8:00 am Registration 9:00 am Start Race Waiver and Release: I understand that my consent to these provisions is given in consideration of the acceptance of this registration and for being permitted to participate in this event. I am a voluntary participant in this event, and in good physical condition. I know that this event is a potentially hazardous activity and I hereby assume full and complete responsibility for any injury or accident which may occur during my participation in this event or while on the premises of this event, and I hereby release and hold harmless and covenant not to file suit against The Community Breast Care Project, The Jefferson City Roadrunners, and any affiliated individuals, any race sponsor and their agents and employees, and all other persons or entities associated with this event from any loss, liability or claims I may have arising out of my participation in this event, including personal injury or damage suffered by me or others, whether same be caused by falls, contacts with participants, conditions of the course, negligence of the sponsors or otherwise. If I do not follow the rules of the event, I understand that I may be removed from participation. Signature:____________________________________ Date: _______________________________________ Start/Finish at North Jefferson City Pavilion 927 Fourth St, Jeff City, MO (Cedar City Pavilion) 573-634-HOPE Register online at communitybreastcareproject.org Door Prizes:: There will be lots of prizes, including prizes from area businesses, You don’t want to miss out on this event. Safe and Enjoyable Course:: Start/Finish at North JC Pavilion. The course will be much flatter than previous years. Our Mission To provide educational, financial and emotional support to the Central Missouri community regarding awareness of breast health and breast cancer treatment. Officers and Board Members Our Officers and Board Members come from all sectors of our community - health care, banking, business and education. We share a common goal of raising awareness and helping women in Central Missouri. Awards: Awards will be given to the overall walker/ runner as well as other top finishers. Age Categories: 14 and Under 15-19 20-29 30-39 40-49 50-59 60-69 70 and over CBCP Board Members Laurelanne Bellezzo Nancy Gratz Linda Harvey Mariam Kuensting Buffy Phillips-Kiss Lorie Smith Vicky Stafford Denise Tritz The Walk/Run Starts Here! The purpose of this event is to help fund the Community Breast Care Project Financial Aid The Community Breast Care Project will provide financial aid to anyone who meets the following requirements: • You must reside in Cole, Callaway, Miller, Moniteau, Morgan or Osage county. • You must have a new diagnosis of breast cancer within the last 12 months. • No more than $500 will be given to any one person To date financial aid checks have helped 106 women in Central Missouri totaling $53,000 in financial aid. Resource Notebooks The Community Breast Care Project provides resource notebooks to area doctors to be given to a patient with a new breast cancer diagnosis. These books are used to keep all of their important papers like their medication journal and their appointment times and doctor contact information. The notebooks also contain encouraging letters from survivors. The Ra Ra Sisterhood The CBCP’s support group is called the Ra Ra Sisterhood with over 55 members who meet once a month to enjoy camaraderie and listen to speakers pertinent to breast cancer survivors. We also exchange encouraging notes and cards when someone is facing treatments or a surgery. Refreshments: Will be provided during the race. Refreshments and fruit will be available after the race. Pre-Registration Required: Make Checks Payable to: Please register by Friday, May 2, 2014, t-shirts guaranteed to all with advanced registration. If you are a walk in shirts will be available on a first come first serve basis and will only be available the day of the race if we have shirts left over after serving all of the pre-registered walk/runners. CBCP Mail to: 2854 S. Ten Mile Drive Jefferson City, MO 65109 Or Fax to: 888-634-5202 Remember to invite all of your friends to join you. North Jefferson City Pavilion 927 Fourth Street Jefferson City, MO (Cedar City)
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