Susan G. Komen Inland Empire Race for the Cure®
Team Reconciliation Worksheet
Team Name: Team Captain:
Street Address: City & State: Zip:
Email: Daytime Phone:
Team Division: Corporate - School/Organization - Friends/Family - High School Team Challenge (please circle one)
Team Photo Reserved? Y N Team Tailgate Reserved? Y N If yes, please fill out reservation form and attach.
Please fill out this form completely before October 2, 2010. Attach all signed team entry forms and donations. If additional worksheets or entry forms
are needed, please make copies or download additional forms at www.komenie.org. RETURN THIS FORM IN PERSON ON OCTOBER 2, 2010
or mail by September 25, 2010 to: Komen Inland Empire Race for the Cure®, PO Box 1858, Fallbrook, CA 92088-1858. All checks should be made
payable to: Komen Inland Empire Race for the Cure® – please do not collect cash. All team entries must be submitted together by October 2, 2010.
All donations must be received by October 31, 2010 to qualify for team credit or by race day to be eligible for the fundraising prizes.
PLEASE DO NOT LIST ONLINE PARTICIPANTS AND/OR ONLINE DONATIONS ON THIS WORKSHEET.
TEAM ENTRY T-SHIRT SIZE
MEMBER FEE SLEEP DONATIONS TOTAL YOUTH
FIRST TEAM MEMBER ENCLOSED IN FOR THE ENCLOSED ENCLOSED ADULT KID’S RUN
INITIAL LAST NAME See Entry Form CURE®* $ $ S M L XL XXL YS YM YL
* Sleep In for the Cure® registrants will be mailed their T-shirt shortly before the event.