MAK E AN IMPACT. | Apr il 28, 201 2
register online at:
GLOBAL M SSION L CAL IMP
Promise Ifor .theo Cure. A C T .
Carol Johnston & Mike Turner honorary Chairs
Allison Van Matre & Casey Cowan Co-Chairs
Cortney Carlson 2012 race Chair
pINNACLe hILLS prOMeNAde
sAturDAy, APriL 28, 2012
M AKE AN IM PACT. | Apri l 2 8, 2 012
L o C A L I M P A C T. G L O B A L M I S S I O N.
NEW FASTER COURSE!
Join us again this year for our 10K course sponsored
by Caltrate. The course is certified by USATF and each
participant will be timed and receive a commemorative
medal. Awards will be given to the top three place
survivors, male and female participants.
Competitive 5K race
The competitive event features a 5K course certified
by the USAFT. This year we are excited to include
chip-timing in your registration fee. The first-place
male, female, and survivor will receive roundtrip air
transportation on American Airlines or American Eagle
to any destination in the contiguous United States.
Limit one (1) ticket per household.
This race is sponsored by Dean foods.
family fun Walk Pasta Party
Not up for the full 5K? Join us for the Family Fun Walk 1K teens for the Cure ® The Washington regional sponsored 2012 Susan G.
course through Pinnacle Hills Promenade Mall sponsored This is a wonderful way for schools in our community Komen Pasta Party has undergone a transformation. Not
by Johnson and Johnson. Bring the whole family and to show their support by putting together a team of only has our venue changed, Pratt Barn of Pratt Inn &
enjoy a more leisurely pace while continuing to make an students to walk, run, cheer or volunteer. Any school or Barn, Fayetteville, AR but so has our menu. Following our
impact against breast cancer. organization that is interested in this philanthropic venue theme this year - Global Mission….. Local Impact
should contact our office at 479-750-7465 to receive a we are having a “Taste of Italy” menu. Several local
packet of information. You will receive a specially restaurants will be providing “tastings” of appetizers,
Bark for the Cure ® designed Teens for the Cure t-shirt. Teens for the Cure is salads, entrée’s and desserts. There will be beverages,
Bring your dog to PetSmart at Pinnacle Hills Promenade sponsored by Academy sports. entertainment and lots of ambience. This year’s event
Mall for the Komen Ozark Bark for the Cure sponsored will be Friday, April 27th from 6:00pm – 9:00pm. Event
by milk-Bone. Walk your best friend through the 1K route tickets are $25.00 per person. Children under 6 eat free.
with a water stop at the end. Prizes will be given in Kids for the Cure ® You can purchase tickets online at komenozark.org or at Volunteers
various categories throughout the event. Full details and Kids 12 and under, along with their parents, are invited the door the night of the event. New and returning volunteers are encouraged to get
special rules can be found on our website. to join in the fun of the post-race party at Kids for the involved. Race volunteers will receive a t-shirt courtesy
Cure ®. Founding sponsor Willard & Pat Walker of Georgia-Pacific, the maker of Quilted
Charitable foundation, inc. and Presenting Sponsor survivor Breakfast Northern and Vanity fair in appreciation
sleep in for the Cure ® Kimberly-Clark invite you to this kid-friendly area NEW THIS YEAR is our drop in survivor breakfast. of their efforts. Georgia-Pacific is the
Not a morning person? Out of town on Race day? Reg- featuring food, fun, and our Kid’s Dash sponsored by Breast cancer survivors and one guest are invited to National Series sponsor of the Volunteer
ister for our Sleep In for the Cure ® program sponsored Kraft foods. Kids will receive a special and uniquely stop by our Survivor Reunion Breakfast sponsored by Recognition Program. For information
by hank’s & more fine furniture. Registration includes a designed Kids for the Cure ® t-shirt. The first 2,000 kids Walmart/sam’s Club. Join us at your leisure in the Food about volunteer opportunities, please visit
special Sleep In for the Cure ® t-shirt mailed to your home on Race day will receive a Kids for the Cure ® race medal Pavilion between 7:00 and 9:00 am. The survivor parade our website atkomenozark.org
prior to the race, if registered by April 13, 2012. sponsored by Pepperidge farm. Parental supervision is required. and photo will start at the Food Pavilion at 7:45 am. or visit volunteer.uark.edu.
G L O B A L M I S S I O N. L o C A L I M P A C T.
Komen ozark race for the Cure
The Ozark Affiliate of Susan G. Komen for the Cure is
all about keeping our PROMISE in our 10 county service
area. This area includes Benton, Boone, Carroll, Crawford,
Madison, Newton, Sebastian and Washington Counties
in Arkansas and Stone and Taney Counties in Missouri.
We join more than 2.5 million breast cancer survivors
and activists around the globe as part of the world’s
largest and most progressive grassroots network fighting
breast cancer. The Komen Ozark Race for the Cure is our
signature event and helps us raise awareness and funds About Susan G. Komen for the Cure
that support our Promise: to save lives and end breast Nancy G. Brinker promised her dying sister,
cancer forever by empowering people, ensuring quality Susan G. Komen, she would do everything in her
care for all and energizing science to find the cures. power to end breast cancer forever. In 1982,
that promise became Susan G. Komen for
the Cure, now the world’s largest breast
Date cancer organization and the largest
Saturday April 28, 2012 source of nonprofit funds dedicated
Location to the fight against breast
cancer with more than $1.9
Pinnacle Hills Promenade Mall, Rogers, AR
billion invested to date. For
Ways to register more information about
• Register online at komenozark.org Susan G. Komen for the Cure,
• Register by mail by detaching the entry form on this breast health or breast cancer, visit
brochure. komen.org or call 1-877 GO KOMEN.
• Register on-site at the following locations and times
• Pinnacle Hills Promenade in Rogers, AR
April 11-27 from 10am-6pm Monday-Saturday is Komen’s rallying cry,
& 1pm-5pm Sundays encouraging women to take an active role in their breast
health—to become educated about breast cancer and
registration office opens 6am, race Day.
understand that being aware is the first step in the
process. Listen for the cheers as you walk or run the
• Fayetteville Mall in Fayetteville AR Race and join in!
April 14th and 15th and April 20th and 21st
from 10am-6pm on Saturday
& 1pm-5pm on Sundays Our Promise
Our Promise is to save lives and end breast cancer
• Race packets may be picked up at either registration office, forever by empowering people, ensuring quality care for
except for the Competitive 5K and 10K packets which are only all and energizing science to find the cures.
available at the Pinnacle Hills Promenade Mall.
survivors are the stars of Komen race for the Cure
teams and an inspiration to us all. Breast cancer survivors
Teams are welcome on Race day. Team registrations must who wish to be recognized may pick up their
be submitted together through your captain. Online complimentary pink cap and pink t-shirt provided by
registration of all teams is encouraged at komenozark.org
Zeta tau Alpha.
or call 479-750-7465 for more information. Every team
registered online allows more money to go toward our
mission. Online early bird registration closes on April 17, ‘In Celebration Of’ &
2012. If you are putting together a team and not
‘In Memory Of’ Back Signs
registering online, you will need to drop these team
packets off on March 29-30, 2012 from 10-5 at the Participants are also invited to recognize
registration location at the Pinnacle Hills Promenade Mall. those special people who have been
Please check our website for more detailed information or touched by breast cancer. “In Memory of”
contact komenozark.org. and “In Celebration of” back signs are
available for all Race participants. The Breast Cancer
The Running Ribbon is a registered trademark of Susan G. Komen for the Cure ® Survivor Recognition Program is sponsored by
Brochure Design Provided by 5 Star Sports Zeta tau Alpha and Bank of America.
oNe eNtry Per PersoN PhotoGrAPhiC AND resuLts reLeAse and WAiVer AND reLeAse of CLAims
i agree that any and all representations made and releases, waivers, covenants, consents and permissions given
BEFORE GETTING STARTED... by me hereunder are given on behalf of me and any and all of my minor children or persons over whom i have
• For fast and secure processing, you guardianship participating in or attending the event.
may register online at komenozark.org.
VISIT • Please print clearly and complete all sections.
• Each form must be signed
I give my consent and permission to The Susan G. Komen Breast Cancer Foundation, Inc. d/b/a Susan G. Komen for
the Cure (“Komen”), its affiliates and races, their sponsors and corporate sponsors, their successors, licensees, and
www.komenozark.org • Team entries of 10 or more must be submitted in one assigns the irrevocable right to use, for any purpose whatsoever and without compensation, (i) any photographs,
videotapes, audiotapes, or other recordings of me that are made during the course of this event (the “Event”); and (ii)
envelope no later than April 6, 2012 for early packet
TO VIEW pick-up.
the results of my participation in this Event (e.g., race time, name, participant number).
COURSE MAPS TYPE OF ENTRY
I understand that (i) my consent to these provisions is given in consideration for being permitted to participate in this
Event; (ii) I may be removed from this competition if I do not follow all the rules of this Event; and (iii) I am a voluntary
OF THE 5K & 10K RACES! Individual Team participant in this Event. I am in good physical condition and am solely responsible for my personal health, safety
and personal property. i know that this event is a potentially hazardous activity and i hereby voluntarily assume full
USATF CERTIFIED RACE COURSE - 5K - AR12003DLP and complete responsibility for, and the risk of, any injury or accident thAt may occur during my participation in
USATF CERTIFIED RACE COURSE - 10K - AR12002DLP this event (iNCLuDiNG, But Not LimiteD to, my fuNDrAisiNG ACtiVities associated with the event) or while
BreAst CANCer surViVor? on the eVeNt premises (CoLLeCtiVeLy, “my PArtiCiPAtioN”). to the fuLLest exteNt of the LAW, i, for
Yes, I would like to be recognized by receiving myself, my next of kin, my heirs, administrators, and executors (CoLLeCtiVeLy, “reLeAsors”), hereby release and
a pink t-shirt and hat hold harmless and covenant not to file suit against (i) KomeN, [AffiLiAte CorPorAte NAme] D/B/A [AffiLiAte
DIRECTIONS Timed 10K Race $30.00 DBA NAme] AND ALL other KomeN Affiliates and their resPeCtiVe DireCtors, offiCers, VoLuNteers,
Participants are encouraged to review primary and
PARTICIPANT Competitive 5K Run - timed $25.00 AGeNts AND emPLoyees; (ii) any event sponsors; and (iii) all other persons or entities associated with this event
alternative routes, carpool and arrive EARLY. Lane closures
on the Race course begin at 7 AM and this will slow traffic Regular 5K - non-timed $20.00 (collectively, the “releasees”) for any injury or damages i might suffer in connection with my participation. this
into the venue. First: MI: Last: release applies to any and all loss, liability, or claims i or my reLeAsors may have arising out of my participation,
1 Mile Family Fun Walk $20.00 including but not limited to, personal injury or damage suffered by me or others, whether such losses, liabilities,
PRIMARY ROUTES Teens for the Cure $10.00 or claims be caused by falls, contact with and/or the actions of other participants, contact with fixed or non-fixed
Traveling north on I-540, take exit 82 and turn right off next Email Address:
Kids for the Cure - ages 12 & under $10.00 objects, contact with animals, conditions of the eVeNt premises, negligence of the releasees, risks not known to
exit. Proceed to the Pinnacle Hills Promenade Mall and turn
left on Promenade Boulevard. Traveling south on I-540, take Address: me or not reasonably foreseeable at this time, or otherwise. i understand that i am solely responsible and liable for
Bark for the Cure $20.00
exit 83 and turn left off the exit, then turn left on New Hope all aspects of my fundraising activities associated with my participation, including, but not limited to, the safe and
Road. Turn right on Promenade Boulevard. Sleep In for the Cure $25.00 lawful conduct of any fundraising activities.
City: State: Zip:
Team Delivery $50.00
ALTERNATE ROUTES [[Note: the following language shall only be included in the waiver if the event is held in California: this release
Traveling north on I-540, take exit 81 and turn right off the Home Phone: ( ) - Pasta Party - Friday, April 27 Qty______X $25.00
exit. Continue on Pleasant Grove Road and then turn left on extends to claims and facts unknown and unsuspected to exist at the time of executing this release. All rights under
Have T-Shirt Mailed to You Qty______X $5.00/shirt section 1542 of the California Civil Code are hereby expressly waived with respect to any of the claims, injuries, or
Dixieland Road. Turn left on New Hope Road, then turn left Age as of April 28, 2012
on Bellview Road. Traveling south on I-540, take exit 85 and Pink Postcard Tribute $5.00 damages described in this release. section 1542 of the California Civil Code reads as follows:
turn left off the exit. Continue on Walnut Street and then turn Gender: F M Add a tax deductible donation $_____ A GeNerAL reLeAse Does Not exteND to CLAims WhiCh the CreDitor Does Not KNoW or susPeCt
right on Dixieland Road. Turn right on New Hope Road, then to exist iN his fAVor At the time of exeCutiNG the reLeAse, WhiCh if KNoWN By him must hAVe
turn left on Promenade Boulevard. TOTAL AMOUNT ENCLOSED $_____
T-shirt size (Circle One): Adult: S M L XL 2XL 3XL mAteriALLy AffeCteD his settLemeNt With the DeBtor.]
rACeDAy reGistrAtioN Costs AN ADDitioNAL $10 Per CAteGory This Photographic and Results Release and Waiver and Release of Claims (collectively, the “Release”) shall be
For the safety of all participants, rollerblades and pets are Youth: S (6-8) LG (14-16) construed under the laws of the state in which the Event is held. In the event any provision of this Release is deemed
discouraged from participating in this event. Thank you for PiNK PostCArD triBute unenforceable by law, (i) Komen shall have the right to modify such provision to the extent necessary to be deemed
A personalized postcard stating that you participated in the Komen Ozark
your cooperation. T-SHIRTS WILL BE DISTRIBUTED ON A FIRST COME, FIRST SERVED Race for the Cure® in celebration of a breast cancer survivor or in memory of enforceable; and (ii) all other provisions of this Release shall remain in full force and effect.
RACE DAY SCHEDULE BASIS, AND UPON SIZE AVAILABILITY. ONLY THOSE 12 YEARS OF someone special will be mailed. Please clearly print the name and complete
address of the person you wish to receive the postcard and the name of the
7 - 9 AM - Drop in Survivor Breakfast (Food Pavilion)
AGE OR YOUNGER WILL RECEIVE A KIDS FOR THE CURE T-SHIRT.
person you are honoring or remembering on the form that follows. Please
I understand that I have given up substantial rights by signing this Release, and have signed it freely and voluntarily
7:30 AM - 10K start include a $5 donation for EACH postcard. without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and
7:45 AM - Survivor Photo & Survivor Parade to Start my NAme__________________________PhoNe #_____________________ unconditional release of liability to the greatest extent allowed by law.
8:00 AM - Competitive 5K run PLeAse seND PostCArD to:
8:30 AM - Non-timed 5K run PAymeNt: NAme__________________________________________________________ Signature of participant (parent/Guardian, if under 18) date
8:30 AM - Bark for the Cure (PetSmart)
______CheCK ______CAsh ______ComP ADDress_______________________________________________________
9:00 AM - 1 Mile Family Fun Walk
9:30 AM - Stage Presentations CC#________________________exP. DAte________ City_____________________________stAte______ZiP________________
10:00 AM - Kids’ Dash (age 5 and under) For EACH postcard, please enclose $5.00 (check or money order). For more than one card,
Signature (parent/Guardian, if under 18) date
please enclose a separate sheet with additional names and addresses. Postcards will be mailed
after the Race. Include amount due on “Entry Form”.
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 reGistrAtioN form
to the Komen Ozark Race for the Cure® Register online at komenozark.org G L O B A L M I S S I O N. L o C A L I M P A C T.