KOMEN DENVER RACE FOR THE CURE ®
Locally presented by: Nationally presented by:
ONE ENTRY PER FORM. This form may be photocopied. Use blue or black ink ONLY.
Event Bib # for Official Use Only
T-Shirt Size BREAST CANCER
WOMEN CO-ED FAMILY S M L XL XXL SURVIVOR
Last First Name
City State Zip
Day F M Date of Birth
Phone - - Sex / /
Entry Race Fees
$ Adult $25
Team Captain: ____________________________
$ 18 & Under $15
Make check payable to:
$ 65 & Over $15 Komen Denver Race for the Cure ®
$ Co Survivor Cap $11- $20 Donation Race Results
The following finishers will be announced at the Awards
$ Three Miles of Men Cap $11- $20 Donation Ceremony:
1st, 2nd, and 3rd place finishers in the Women's and Co-ed races
(male and female); the top three overall breast cancer survivors;
$ Donation the first place Masters Survivor (age 40-59); and the first place
Senior Survivor finisher (60+).
Race results will be tabulated for the first 1,000 who complete the
$ $25/yr Membership: Denver Affiliate Women's and Co-ed events. For race results visit our website at
www.raceforthecure-denver.com on October 8.
$ GRAND TOTAL Enclosed
This event will occur rain or shine. We reserve the right to cancel in extreme circumstances. In that event, there will be no refunds,
rather, your entry fee will be used as a donation to the Komen Denver Race for the Cure® . For the safety of all participants, our
insurance company requests that headsets, rollerblades, inline skates, and pets not be allowed on the course.
Waiver & Release -- Please Read & Sign:
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 SUSAN G. KOMEN BREAST CANCER FOUNDATION,
INC., ITS LOCAL AFFILIATES AND ANY AFFILIATED INDIVIDUALS, THE KOMEN DENVER RACE FOR THE CURE ® AND ANY AFFILIATED INDIVIDUALS, ANY RACE
SPONSORS AND THEIR AGENTS AND EMPLOYEES, AND ALL OTHER PERSONS OR ENTITIES ASSOCIATED WITH THIS EVENT (THE "RELEASES") FROM ANY LOSS,
LIABILITY, DAMAGE, OR CLAIMS I MAY HAVE ARISING OUT OF MY PARTICIPATION IN THEIR EVENT, INCLUDING PERSONAL INJURY OR DAMAGE SUFFERED BY ME
OR OTHERS, WHETHER SAME BE CAUSED BY FALLS, CONTACT WITH OTHER PARTICIPANTS, CONDITIONS OF THE COURSE, NEGLIGENCE OF THE RELEASES OR
OTHERWISE. If I do not follow all the rules of this event, I understand that I may be removed from the competition. I give my full permission to the Komen Foundation and its local
Affiliates and Races and their sponsors and corporate partners to use any photographs, videotapes, or other recordings of me that are made during the course of the event.
NOTICE OF DRUG TESTING: Participants in this competition may be subject to formal drug testing in accordance with USAT&F rules and IAAF Rule 144. Participants who refuse
to be tested or who test positive for banned substances will be disqualified from this event and will be ineligible for future competitions.
SIGNATURE OF PARTICIPANT OR PARENT/GUARDIAN IF UNDER 18 DATE
COMPLETE & SIGN ONE FORM PER PERSON.