TAKE THE FIRST STEP: REGISTER ONLINE AND SAVE! AveraRaceSiouxFalls.org 100 percent of all proceeds from the Avera Race Against Breast Cancer will go towards enhancing cancer care for people right here in Sioux Falls and in our neighboring communities. Every penny stays local to help your families, friends and neighbors get the treatment and support they need. Race Day: • • • 05.09.15 AVERA MCKENNAN FITNESS CENTER 3400 S. SOUTHEASTERN AVE. AveraRaceSiouxFalls.org 7:45 a.m. warm-up 8 a.m. race begins (walk/run with staggered times and chip-timed start) Breakfast buffet to follow Participants can choose from a 5K or 10K competitive run, a 3-mile walk or a 1.5-mile family fun walk. Fundraising Opportunities It’s easy to make an even greater impact. Simply register and create your own personal page at AveraRaceSiouxFalls.org. Email the link to family, friends and coworkers, encouraging them to honor your race participation with a gift. Call 605-322-8900 to learn more! AveraRaceSiouxFalls BENEFIT ING #CelebrateHeroes FIRST NAME MI LAST NAME TEAM NAME TEAM CAPTAIN ADDRESS CITY EMAIL ADDRESS ( ) STATE COUNTRY – TELEPHONE (XXX-XXX-XXXX) APT # POSTAL CODE M BIRTHDATE (MM/DD/YY) F GENDER SignatureDate Select race: m 10K run m 5K run m 3-mile walk m 1.5-mile family fun walk m Packet only (race bag, shirt and other giveaways) Select shirt size: Adult m XS m S m M m L m XL m XXL Youth m S (6-8) m M (10-12) m L (14-16) Register online at AveraRaceSiouxFalls.org for only $35! Offline registration by May 8: m Runners and walkers $40 Registration cost on Race Day: m Runners and walkers $45 ______________________________________________________________________________ Please bill my: m American Express m I am a cancer survivor m Breast cancer (You will receive a complimentary PINK survivor long-sleeve T-shirt.) m Other cancer (You will receive a complimentary WHITE survivor long-sleeve T-shirt.) m I am unable to participate, but enclosed is my _______________________________________________________________ Race Release: I hereby for myself, my heirs, personal representatives and administrators waive, release and forever hold harmless Avera McKennan Hospital & University Health Center and Avera Cancer Institute along with their officers, employees, agents and volunteers from any and all rights and claims for damages (including costs) I may have for any and all injuries which may be suffered by me in connection with my voluntary participation in this Avera Race. I also give Avera McKennan and the Avera Cancer Institute the right to use my image or likeness in promotional materials for future Avera Race events and forever waive any and all rights to royalties. ______________________________________________________________________________ If under 18, signature of parent or guardian Date tax-deductible contribution in the amount of $ __________ MAIL TO: Avera McKennan Foundation, 1325 S. Cliff Ave., Sioux Falls, SD 57105 PLEASE DO NOT MAIL FORMS AFTER MAY 1. m Discover m MasterCard m Visa Credit card number _______________________________________________________________ Exp. date CVV code _______________________________________________________________ Name on the card _______________________________________________________________ Signature 15-FDTN-0057
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