ithemba entry form 2014

4
Join us in the crusade against breast cancer 5km and 8km Fun Walk Get event info and enter online at www.ithembawalkathon.co.za For enquiries please call 0861 00 99 02 or email [email protected] Sunday 26 October 2014 Marks Park Sports Complex, Judith Road, Emmarentia dŚĞ ĮƌƐƚ ϭϲ ϬϬϬ ƐƵĐĐĞƐƐĨƵůůLJ ƌĞŐŝƐƚĞƌĞĚ ĞŶƚƌĂŶƚƐ ĂƌĞ ŐƵĂƌĂŶƚĞĞĚ ĂŶ ĞǀĞŶƚ ŐŽŽĚŝĞ ďĂŐ ǁŚŝĐŚ ŝŶĐůƵĚĞƐ ĂŶ ǀŽŶ :ƵƐƟŶĞ ƉƌŽĚƵĐƚ ĂŶĚ ĂŶ ĞǀĞŶƚ ƚͲƐŚŝƌƚ ƌŝŶŐ LJŽƵƌ ĐĂŶŝŶĞ ĨƌŝĞŶĚ ƚŽ ũŽŝŶ ŝŶ ƚŚĞ ĨƵŶ ǁŝƚŚ ƚŚĞ EƵƚƌŝƉŚĂƐĞ ŽŐ tĂůŬ Ăƚ ŶŽ ĞdžƚƌĂ ĐŚĂƌŐĞ ŶƚĞƌƚĂŝŶŵĞŶƚ ĨŽƌ ƚŚĞ ǁŚŽůĞ ĨĂŵŝůLJ ŝŶĐůƵĚŝŶŐ ĐŚŝůĚƌĞŶƐ ƉůĂLJ ĂƌĞĂ ƚŽĚĚůĞƌ ƚƌŽƚ ůŝǀĞ ŵƵƐŝĐ ƐƚĂŐĞ ƉĞƌĨŽƌŵĂŶĐĞƐ ƉƌŝnjĞ ŐŝǀĞĂǁĂLJƐ ĐĞůĞď ŐƵĞƐƚ ĂƉƉĞĂƌĂŶĐĞƐ ĂŶĚ ĨŽŽĚ ƐƚĂůůƐ tĞǀĞ ƌĞƚƵƌŶĞĚ ƚŽ ŽƵƌ ŽƌŝŐŝŶĂů ƐƚĂƌƚ ƟŵĞƐ ĂŶĚ developed a new route to bring you an even ďĞƩĞƌ ϮϬϭϰ ŝdŚĞŵďĂ tĂůŬĂƚŚŽŶ ^ƚĂƌƟŶŐ ƟŵĞ 8:00am 8km & 8:30am 5km for for Our media partners: Our NGO partners: FUN WALK for the whole FAMILY Zϵϱ ƉĞƌ ĂĚƵůƚ ǁĂůŬĞƌ Zϳϱ ĨŽƌ ĐŚŝůĚƌĞŶ ƵŶĚĞƌ ϭϮ ĐŚŝůĚƌĞŶ ƵŶĚĞƌ Ϯ ĂƌĞ ĨƌĞĞ ʹ ƉƌĂŵƐ ƉĞƌŵŝƩĞĚ EK EdZ/^ t/>> Wd KE d, z &Žƌ LJŽƵƌ ƐĂĨĞƚLJ ŽĸĐŝĂůƐ ƌĞƋƵŝƌĞ Ăůů ǁĂůŬĞƌƐ ŽůĚĞƌ ƚŚĂŶ Ϯ LJĞĂƌƐ ƚŽ ƌĞŐŝƐƚĞƌ ĂŶĚ ǁĞĂƌ ƚŚĞŝƌ ǁĂůŬ ŶƵŵďĞƌƐ ŽŶ ƚŚĞ ĚĂLJ Entries close: 12 October 2014 Team entries (10 or more) close 05 October 2014

Upload: compassionhat

Post on 20-Jul-2016

20 views

Category:

Documents


1 download

DESCRIPTION

Avon Justine iThemba Walkathon 2014Fun for the whole family.Sunday 26 October 2014Marks Park Sports ComplexJudith RoadEmmarentia, Jhb

TRANSCRIPT

Page 1: Ithemba Entry Form 2014

Join us in the crusade against breast cancer 5km and 8km Fun Walk

Get event info and enter online at www.ithembawalkathon.co.za For enquiries please call 0861 00 99 02 or email [email protected]

Sunday 26 October 2014Marks Park Sports Complex, Judith Road, Emmarentia

developed  a  new  route  to  bring  you  an  even  

8:00am 8km & 8:30am 5kmfor for

Our media partners: Our NGO partners:

FUN WALK  for the whole FAMILY

Entries close: 12 October 2014Team entries (10 or more) close 05 October 2014

Page 2: Ithemba Entry Form 2014

ENTRY FORMWe require a signed and completed entry form per walker. Photocopies of the 2014 entry form will be accepted.Please take note of the rules and requirements in order to ensure your entry is captured within the first 16 000 to qualify for a Goodie Bag.

Name:

Are you entering as a team of 10 or more? Place TEAM name here:

Team Captain (ALL entrants to complete individual entry forms)Male Female

5km 8km

Yes No

Total:

Daytime Telephone Number: Cell Number

PAYMENTS AND DONATIONS

Email:

ID/Passport Number:

D D M M Y Y Y YDate of birth:

Suburb:

Emergency Contact Name:

Discovery Vitality Number:

Any serious medical problems we should know about?

Emergency Contact Cell Number:

Surname:

Would you like to receive info re: Avon Justine cause events:

Yes No

Individual entries close at midnight Sunday 12 October 2014. Late entries will be accepted at registration @ R145 per adult plus a free event T-shirt and R75 per child over 2 years old without an event T-shirt. Goodie Bags will be given to the first 16 000 entrants only. Team entries close at 18h00 on 05 October 2014.Thank you for applying to enter the Avon Justine iThemba Walkathon. Please remember that you are NOT ENTERED until payment has been received and captured against your entry.We require all the info highlighted as mandatory fields along with a signature below in order to successfully capture all relevant info.

T-shirt Size - Adults:One size completed per entry

T-shirt Size - Children:

DISCLAIMERI acknowledge and agree that Avon Justine, its employees and agents, the iThemba Crusade of Hope, sponsors, suppliers and volunteers associated with the event will not accept responsibility for injury, damage or loss of any nature whatsoever which may result from participating in the Avon Justine iThemba Walkathon for the iThemba Crusade of Hope, and I declare that I am participat-ing in the Avon Justine iThemba Walkathon entirely at my own risk even if I have not read this disclaimer and someone has entered on my behalf. If the event / walk should be cancelled owing to circumstances beyond the control of the organisers, no refunds will be granted. Note: consult a medical practitioner before engaging in any physical activity. Participants walking their dogs take full responsibility for their dogs and indemnify and hold Avon Justine harmless for any loss, damage or injury caused to any person or property by their dog(s) in any manner whatsoever.Entry into the iThemba Walkathon requires a proof of payment to accompany the entry form before the entry deadline in order to validate the entry and goodie bag qualification.

Signature of entrant (and parent / guardian if entrant is under 18 years):

Adult Walker: R95

Children 2 -12: R75

Donation (Optional)

Discovery Vitality members earn Discover Vitality points when walking. 5km and 8km earns you 500 points. Your points will be rewarded within the month subsequent to the walk.

Teams consist of a minimum of 10 entrants. Entry of the first 9 entrants will be processed and individual entries.

TTeam collections at registration to be done by the team captain only. No individual/ part entry collections will be permitted.

Please note the mandatory fields marked with

Page 3: Ithemba Entry Form 2014

REGISTER NOW! JOIN IN THE FIGHT AGAINST BREAST CANCERWear your most creative outfit and make sure you stand out to be in line to win awesome prizes!

Important Event Information and Rules:

Submission of Entries and Proof of Payment

What constitutes a successful entry: All entries require an entry from that is fully completed and TOGETHER

with proof of payment. Your entry will only be deemed complete and successful for processing once we have received the completed entry form AND matching payment. Please ensure proof of payment is correctly cross-referenced. If you do not receive confirmation of your entry via email or text within 72 hours, please contact us on 0861 00 99 02.

Team Entries: Complete and pay for all team entries in one payment. Your team captain

must collect at registration for the whole team. Please use your team name as your reference if paying by EFT or Direct Deposit.

Online Entries: Enter online at www.ithembawalkathon.co.za and pay with your credit or

chip and pin based debit card. Your entry will be confirmed after payment is reflected in our bank account and you’ve received an entry reference by email within 72 hours of entering. Please ensure you contact us if you do not receive confirmation. Team entries can be done online but please note that all team members have to complete a separate entry form and team entry payment must be made by one person for all team members at the same time. Remember that team entries close 05 October 2014 while individual online entries close 12 October 2014.

Fax Entries: You can complete a photocopied original or download a 2014 Avon

Justine iThemba Walkathon entry form, make a deposit/ EFT into the account (details below) and make sure that you fax your completed entry form/s with your mandatory proof of payment to 0866209820.

Please use your first name and surname as your reference when making payments.

Hand Delivered Entries: Complete your entry form and pay at the till then drop it [with the receipt/

proof of payment] at the following Sportsmans Warehouse stores: - Blackheath Pavilion, Cresta - Fourways Crossing Retail Centre, Lonehill - The Glen Shopping Centre, Oakdene - Woodmead Super Value Centre, Woodmead - Princess Crossing Shopping Centre, Roodepoort Please use your first name and surname as your reference when making

payments.

Account Details: First National Bank

- Acc No.: 62362583819 - Acc Name: BrandAXN T/A iThemba - Branch Code: 260548 - Current Account

Note: The account will close after entry closing dates, if you would like to enter after these dates enter at go to Marks Park during registration.

See late registration details.

Nutriphase Dog Walk Bring your dog to take part in the Walkathon!

may want to bring extra water and snacks for them

Registration

Goodie bags consisting of an Avon Justine product and an event t-shirt will be given to the first 16 000 successfully registered entries received by 12 October 2014. Goodie bags are only guaranteed to the first 16 000 successfully registered entrants so it is advisable to enter as early as possible. All walker numbers and goodie bags should be collected at Marks Park Sports Complex from:

Thursday, 23 October: 10h00 to 18h00

Friday, 24 October: 10h00 to 18h00

Saturday, 25 October: 9h00 to 16h00

Late Registration:

If you miss the closing date for online and fax entries, you are still welcome to enter at Registration from 23rd to 25th October 2014 at the above times.

2 years of age without an event T-shirt (prams permitted).

On the Event Day:

Kaya FM presenters and other celebrities as well as other breast cancer survivor.

including the Nutriphase Dog Walk.

in to 95.5 for live updates regarding traffic and parking on the day from 06h00am.

NGO Partners Bossom Buddies, Look Good…Feel Better and iThemba.

Bring Along:

everyone you know to register to walk or come to support the walk.

registration/walk number collection from Thurs 23 October.

Rules:

All walkers must be pre-registered.NO entries will be accepted on the day of the event. Only pre-entries will be accepted.

unattended children on the grounds. Wristbands will be provided.

duration of the walk.T-shirt size changes will not be permitted at registration as they have been ordered according to quantity.

www.ithembawalkathon.co.za for parking info.

Nutriphase Dog Walk.

Goodie Bags.

EARLY DETECTION SAVES LIVES

Page 4: Ithemba Entry Form 2014

Register Now and walk with your whole family, friends, colleagues and community.Experience the fun including live performances, prize giveaways, stalls, children’s play area,

vendors, exhibitors and a lot more at this years Walkathon.Corporate hospitality packages are available.

FIND US ON FACEBOOK AND TWITTER: AVON JUSTINE ITHEMBA CRUSADE OF HOPEwww.avon.co.za | www.justine.co.za

Want to further support the work of our NGO partnersSend an sms to one of the following two numbers and all proceeds will be donated to the iThemba Fund:

SMS “breast cancer” to 41131 to donate R25 or SMS “breast cancer” to 38844 to donate R10.

Avon Justine iThemba Crusade of Hope

iThemba believes that community education and awareness are key to early detection. The more women know about breast cancer, the more women we will be encouraged to do monthly self-examinations and annual mammograms. The Avon Justine iThemba Crusade of Hope donates products worth R180 000 annually to Look Good...Feel Better, an organisation that helps women undergoing active cancer treatment in a practical and empowering way through their workshops.

Avon Justine iThemba CANSA Units

iThemba has funded a CANSA mobile unit in the Free State to promote awareness of breast and cervical cancer in the rural areas. The units also conduct pap smears and breast examinations. The iThemba CANSA unit in the Free State reached 14 098 women during 2011 and 2012.

Avon Justine iThemba Mobile Breast Cancer Educational Units

The Avon Justine iThemba Breast Health Foundation educational units’ talks have reached over 95 521 women in the Sedibeng region since 2010, the Western Cape unit has reached over 71 905 over the same period.

“The two biggest stumbling blocks in breast health care in South Africa are awareness and access. The Avon Justine iThemba relationship with the Breast Health Foundation, through mobile education units, donations and involvement with the walkathon beautifully addresses both these issues.” says Dr Carol-Ann Benn.

Avon Justine iThemba Ladies’ Days

In 2013 the iThemba Ladies Day was attended by 320 incredible women. The Avon Justine iThemba Ladies’ Day raises funds for Look Good… Feel Better through ticket sales and the silent auction. Over R150 000 was raised. Visit www.ithembaladiesday.co.za for more.

The Work of our NGO PartnersGet your family, friends and community to sponsor you per km you walk.

Visit ithembawalkathon.co.za for more info.

EARLY DETECTION SAVES LIVES

https://twitter.com/ithembacrusade@ithembacrusade

The Breast Health Foundation and Bosom Buddies were established in 2002 to educate the public on breast cancer and breast health, increase awareness and empower women.

Please visit our website for more info. www.mybreast.org.za / www.bosombuddies.org.za

The Look Good…Feel Better programme is the cosmetic industry helping cancer patients undergoing active treatment, in a practical and positive way. Over 22 000 cancer patients have now attended a Look Good…Feel Better workshop in South Africa.Please visit our website for more info. www.lgfb.co.za

Raise funds - get your family, friends and community to sponsor you for each km you walk.Visit www.ithembawalkathon.co.za for more info.

Want to further support iThemba work of NGO’s? Download entry form and challenge team mates to walk too!