FATHERSDAYRUN.CA

Join the fight against prostate cancerSunday, June 19, 2011Malvern Community Centre Track

Scarborough support the men you love

Event DetailsLocation: Malvern Community Centre Track30 Sewells Road at Neilson Rd. Free parking.

Event Day Registration: 8:00 am

Event Start Time: 10:00 am

Additional Information: 5K walk/run, kids’ fun run. We welcome strollers, wagons and leashed pets. Please no bikes, blades or boards.

Getting StartedSet your goals. Fundraise $150 or more in donations and your registration fee of $35 will be waived*. Kids 12 and under are free.

Register ONLINE

Visit FATHERSDAYRUN.CA

1. Create a personal or team fundraising page.

2. Learn fundraising tips, track your team and personal fundraising progress and share your stories.

Instant tax receipts will be issued when donations are made online.

Pre-RegistrationAvoid registration lineups on event day by bringing your completed forms and donations to pre-registration. Dates and locations available at FATHERSDAYRUN.CA

Day of EventBring completed forms and donations on Walk/Run Day. Come early to avoid the rush!

* Registration fees are not eligible for tax receipts and are non-refundable.

What We DoProstate Cancer Canada raises funds for the development of programs related to awareness, public education, advocacy, support of those affected and research into the prevention, detection, treatment and cure of prostate cancer.

Prostate Cancer Facts• Prostate cancer is the most common cancer to af�ict

Canadian men.

• During his lifetime, 1 in 6 men will be diagnosed with the disease.

• Prostate cancer is over 90% curable if detected and treated in its earliest stages.

• Visit prostatecancer.ca for more information or to view our early detection guidelines.

Like us on Facebook – www.Facebook.com/ProstateCancerCanada

Follow us on Twitter – @ProstateCancerC

Scan to register

FIRST NAME

PERSONAL INFORMATION

TEAM MEMBER INFORMATION

PLEASE PRINT

You can place all of�ine cash donations on your credit card to receive donor receipts instantly. Please ensure cheque donations are made payable to Prostate Cancer Canada.

LAST NAME

Are you a prostate cancer survivor?

I will collect $150 in donations (Reg. fee will be waived)

$35 Registration Fee payment method

Cash Cheque Credit Card

Card#:

Exp. date:Waiver: In signing this release, I acknowledge that I understand the intent thereof, and I hereby agree and absolve and hold harmless Prostate Cancer Canada, corporate sponsors, co-operating organizations and any other parties connected with this event in any way, singly or collectively, from and against any blame and liability for any injury, misadventure, harm, loss, inconvenience, or damage hereby suffered or sustained as a result of participation in the Safeway Father’s Day Walk/Run for Prostate Cancer or any activities associated therewith. I hereby consent to and permit emergency treatment in the event of injury or illness. I also give full permission for use of my name and/or photograph in promotions, publications or advertising connected with this event.

Signature (applies to credit card authorization and waiver) If participant is under 18 years of age, parent or guardian must sign.

AGE GENDER

SUITE/APT. # STREET CITY PROVINCE POSTAL CODE

E-MAIL

DONATION AMOUNT

M

TELEPHONE # HOME BUSINESS

F

YesYes

Donation Form

Register Online, it’s easy: Visit FATHERSDAYRUN.CA

For more registration forms visit FATHERSDAYRUN.CATAX RECEIPT INFORMATIONReceipts will automatically be issued for donations of $20 or more. For donations of less than $20, receipts will be issued upon request. Donor’s name and address must be complete and legible to receive a tax receipt. NOTE: It is the donor’s responsibility to be in compliance with the Income Tax Act and policies of Canada Revenue Agency. Charitable Registration # BN 89127 0944 RR001

FIRST NAME

E-MAIL

CASH CHEQUE CREDIT CARDNAME ON CARD NAME ON CARD CARD # EXPIRY

TELEPHONE #

LAST NAME

SUITE/APT # CITY PROVINCE POSTAL CODESTREET

1$

XFIRST NAME

E-MAIL

CASH CHEQUE CREDIT CARDNAME ON CARD NAME ON CARD CARD # EXPIRY

TELEPHONE #

LAST NAME

SUITE/APT # CITY PROVINCE POSTAL CODESTREET

2$

XFIRST NAME

E-MAIL

CASH CHEQUE CREDIT CARDNAME ON CARD NAME ON CARD CARD # EXPIRY

TELEPHONE #

LAST NAME

SUITE/APT # CITY PROVINCE POSTAL CODESTREET

3$

XFIRST NAME

E-MAIL

CASH CHEQUE CREDIT CARDNAME ON CARD NAME ON CARD CARD # EXPIRY

TELEPHONE #

LAST NAME

SUITE/APT # CITY PROVINCE POSTAL CODESTREET

4$

X

CHARGE ALL DONATIONS TO MY CREDIT CARDCARD #

TOTAL DONATIONS $AMOUNT TO BE CHARGED $ NAME ON CARD

Learn fundraising tips, track your team and personal fundraising progress and share your stories.

Tax receipts will be issued quickly and ef�ciently.

Register online and raise $1,000 or more by Sunday, June 19, 2011 and you will be entered in a draw to WIN a trip for 2 to any Air Canada destination.

If you decide not to register online, complete the donation form provided below.

TEAM TYPE: CORPORATETEAM NAME TEAM CAPTAIN’S NAME

FRIENDS & FAMILY SCHOOL SURVIVORS