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