The Colony Courier-Leader (The Colony, Tex.), Vol. 26, No. 16, Ed. 1 Wednesday, May 23, 2007 Page: 30 of 31
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Page 10 — Star Community Newspapers — May 23,2007
FRIENDS FOR THE CURE® DONATION FORM
May 23,2007 — Star Community Newspapers — Page 11
KOMEN NORTH TEXAS REGISTRATION FORM
Fayse-
Collect donations online! Go to race.komennorthtexas.org to start your personal Friends for the Cure website.
The Friends for the Cure Program, locally sponsored by Kroger, offers you the opportunity to further support the North
Texas Affiliate of Susan G. Komen for the Cure by seeking donations from family, friends and co-workers. If your employer
has a Matching Gift program, your donation will go twice as far. Please attach the necessary Matching Gift form(s) and
required documentation to this form. Donations must be turned in by 8 a.m. on Race day to qualify for grand prizes.
Photocopied entry forms are acceptable, but the form must
not be altered in any way.
Individual Registration
, Last Name:
Address:
For office use only.
email address
First Name:
Phone:
BIB#
New for 2007
Be one of the top 10 Friends for the Cure® fundraisers and
you and your guest will enjoy a night at the Dr. Pepper
Ballpark. You won’t want to miss the July 11th game when
the Frisco RoughRiders play the Corpus Christi Hooks. Soft
drinks, hotdogs and baseball — all hosted by Kroger!
PRIZES
City:
State: ZIP:
Date of birth (mmddyy):
Age:
Please complete:
Participant’s Name:
Team Name:
(if applicable)
Address:
City:
State:
ZIP:
Phone (Day):
Phone (Evening):
email:
Make checks payable to: Komen NTX RFTC.
Donor’s Name
Phone
$ Amt.
$
$
$
$
$
$
$
$
$
$
$
$
Every Race participant who sets up an online Friends for the Cure
donation page and raises $100 or more is eligible to win a $100 gift
certificate from Frisco Gold and Silver In addition, all participants who
pick up their FFTC prizes on or before Race day are eligible to win a
second drawing for a $100 gift certificate from Frisco Gold and
I am a Breast Cancer Survivor of
years.
Payment information:
06702/07
1st place
2nd place
3rd place
$100 - $249
$250 - $499
$500 - $999
over $1,000
$1,000 Kroger gift card, Cooper Spa at Craig Ranch
Elegant Escape Package and six-month membership
to Cooper Aerobics Center at Craig Ranch
Round trip air transportation on American Airlines or
American Eagle to any destination in the contiguous
U.S. (Limit (1) ticket per household) and six-month
membership to Cooper Aerobics Center at Craig
Ranch
Two nights for two, including breakfast, at The Marriott
at Legacy Town Center and one-month membership
to Cooper Aerobics Center at Craig Ranch
$10 Kroger gift card
$25 Kroger gift card and an additional gift
$50 Kroger gift card and an additional gift
$100 Kroger gift card and $50 New Balance gift card
Online donation deadline for prize eligibility is midnight
May 28, 2007.
503(b) Tax 75-2356437
Donor’s Name
Phone
$ Amt.
$
$
$
$
$
$
$
$
$
$
$
$
If every Race participant collected $100, we could raise an
additional $1,500,000 toward our promise of saving lives
and ending breast cancer forever!
TOTAL DONATIONS
$
This form may be photocopied.
1 would like to be recognized as a breast cancer
survivor by receiving a special survivor Race bib,
pink t-shirt and cap.
This is my first time to participate in the Komen North
Texas Race for the Cure®.
Short Sleeve T-Shirt Size:
Cash
Credit Card
Number
MC
Check (check #
Visa
Exp.
)
Akante
Youth L
Adult:
S
M
L
X-L
XX L
XXX-L
(T-shirts guaranteed to first 14,000 registrants only.)
Entry Fees (non-refundable):
Early Registration $25 (postmarked by 5/19)
Late Registration $30
12 and under and 65 and over $15
I wish to be chip timed $3
I have a personal chip number
in the Pink $65
Sleep In for the Cure® $35
Packet Mailing $6
Pink Ribbon Tree
$
$
$
$
S.
$
$
# of small ribbons @ $
$2. In honor of or in memory of:
Elizabeth’s Garden Tulips # @ $10 $
(Please use separate order form to specify
wording for Tulip.)
Additional Contributions
TOTAL
Online Registration
race.komennorthtexas.org
We encourage you to register
online with credit card payments
via a secure site. Online
registration ends at I I p.m..
May 28, 2007.
$
$
Three-Digit Security Code___________________________
Register online at race.komennorthtexas.org until May 28, 2007,
at 11 p.m.
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
North Texas Race for the Cure®.
RACE WAIVER AND RELEASE
(must be signed by participant)
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
HAZARD I S AC I TV ITY AND I HEREBY ASSU ME FT ILL AND COMPL ETE RESPONSIBIL TTY FOR
ANY INJURY OR ACCIDENT WHICH MAY OCCUR DURING MY PARTICIPATION IN THIS EVENT
OR WHILE ON THE PREMISES OF THIS EVENT. AND 1 HEREBY RELEASE AND HOLD HARM
LESS AND COV ENANT NOT TO FILE SUIT AGAINST THE SVSAN G. KOMEN BREAST CANCER
FOL ND ATION, INC . DBA SUS A N G. KOMEN FOR THE CI IRE. US LOCAL AFFILIATES AND A NY
AFFILIATED INDIV IDLAI S. THE KOMEN NORTH TEXAS RACE FOR THE CURES AND ANY
All ILIATE D INDIVIDL JAL S. A NY RACE SPONSORS AND TH El R AGENTS AND EMPLOY EES. AND
ALLOTHER PERSONS OR ENTIT TES ASSOCIATED WITH THIS EVENT (THE "RELEASEES") FROM
ANY LOSS, LIABILITY OR CLAIMS I MAY HAVE ARISING OF T OF MY PARTICIPAT ION IN THIS
EVE NT. INCLUDING PERSONAL INJURY OR DAMAGE SUFFERED BY ME OR OTHERS. WHETHER
SAME BE CAUSED BY FALLS, CONTACT w fl H PARTICIPANTS. CONDITIONS OF THE COURSE.
NEGLIGENCE OF THE RELEASEES OR OTHERWISE. If I do not follow all the rules of this
event, 1 understand that I may be remov cd from the competition. I give my full permission to
Komen and its local Affiliates and Races and their sponsors and corporate sponsors to use any
photographs, videotapes, audiotapes or other recordings of me that are made during the course
of this event. I understand thal this Waiver and Release may be stored electronically and agree
that a copy is authentic and admissible as evidence in any future dispute or proceeding.
SIGNATURE
Parent or Guardian
Signature required if under age 8
Date
Cut along dotted line
WAYS TO REGISTER
Mail-in Registration
Must be postmarked by May 19.
Send completed and signed
registration forms to:
Individual Registration
Komen North Texas
Race for the Cure .
7200 Bishop Road, #D-8
Plano, TX 75024
Walk-in Registration and
Packet Pick-up
Visit us at our packet pick-up
location at Luke’s Locker in
The Shops at Legacy.
May 30 10 a.m. - 8 p.m.
May 31 10 a.m. - 8 p.m.
June 1 10a.m. - 2 p.m.
Or, register Race morning
6:30 - 7:45 a.m.
For the safety of all participants,
inline skates, bicycles and pets
are discouraged in this event.
Thank you for your cooperation.
wen
"Wisnoo
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Bick, Jack & Crimmins, Blaine. The Colony Courier-Leader (The Colony, Tex.), Vol. 26, No. 16, Ed. 1 Wednesday, May 23, 2007, newspaper, May 23, 2007; The Colony, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1621969/m1/30/?q=architectural+drawings: accessed July 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting The Colony Public Library.