ALL PROCEEDS BENEFIT SUSAN G. KOMEN FOUNDATION HELPING IN THE FIGHT AGAINST BREAST CANCER

The 1st 5k Duck Duck Run for the Cure
Benefiting Susan G. Komen Foundation (Breast Cancer)

WHEN: June 19, 2010 with a 9:00 am start time
WHERE: Across from Trailside Park, west of N. Central Ave. & Searls Park on Stafford Road in Rockford, IL.
COST: $25 Tee shirts are limited so register today!

FREE DUCK ENTRY FOR THE DUCK DERBY AT MAGIC WATERS ON JUNE 26, 2010!!

PACKET PICK UP: June 18, 2010 from 3:00 pm to 7:00 pm at Burpee Center at Rockford College, 5050 E. State St. Rockford, IL 61108 or at the race before 8:45 am. Packets will include your bib numbers, coupons to local businesses, 1 entry to the 2010 DUCK DERBY/Coupon for $9.45 off a ticket at Magic Waters on June 26, 2010, a tee shirt, and various other goodies.

Please visit www.duckderbyforthecure.com to learn more about the DUCK DERBY and how you can help in the fight against breast cancer or email duckduckrun@yahoo.com

Awards will be given to male & female 1st/2nd/3rd place finishers in each age division
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MAIL ENTRY TO: Jonica Trude, 1704 Latham St Rockford, IL 61103. Make checks payable to SUSAN G. Komen Foundation
Questions: Please call Jonica Trude at 815-543-7015 or email duckduckrun@yahoo.com
ENTRY FORM
Name:______________________________________ Male__ Female__
Address:___________________________________________________
Birthday: ___/___/___
Circle: 3-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Shirt size S___ M___ L___ XL___
YOU MUST SIGN THIS WAIVER
I understand the dangers and hazards inherent to a recreational activity such as the DUCK DUCK RUN including but not limited to: falls, weather, other participants, heat, and conditions of the trail. I, _________________________________ here by voluntarily agree to assume all risks and responsibilities to which I will be exposed to during participation in this event. Further, I do, hereby agree to waive and release, DUCK DUCK RUN, DUCK DERBY, Rockford Park District, Rockford Road Runners, all race sponsors, all volunteers, promoters, and event staff from all claims or liabilities of any kind arising from my participation in this activity even though it may be on the part of the persons or parties named in this waiver. I verify that I am physically fit (verified by a licensed doctor), and prepared to participate and complete this event.
Participants Signature____________________________________ Date _______
Parent’s Signature (if under 18 yrs old) _________________________Date _____