Registration FormPlease indicate the event you are registering for:

Adults $35.00 � 3K Walk � 5K Run/WalkYouth (13 to 17) $20.00 � 3K Walk � 5K Run/Walk12 and under FREE* � 3K Walk � 5K Run/WalkFamily (Maximum 2 Adults)* $70.00* an adult must be on site if participant is under the age of 12

Race date:

Race location:

Name:

Address:

City: Postal Code:

Day Phone:

Email:

Company:

Gender: Age: YYYY / MM / DD

Do you want to fundraise for the CDA? � Yes � No

Circle your payment option: � Visa � MC � Cheque(cheque payable to the Canadian Diabetes Association)

Card Number:

Expiry: Signature:

Cost: CDA Donation:

Total amount being charged:

Signature: Date:

A registration form and waiver (on back of this form) must be completed for all individuals including children. Questions? Please contact Caitlin at info@thefreedomrun.ca or 1-800-226-8464 ext. 7067

Mail form and payment to: Canadian Diabetes Associationc/o The Freedom Run1400 – 522 University Ave., Toronto, ON M5G 2R5

To register on-line, please go to www.thefreedomrun.ca or www.runningroom.com

Raise Funds! In addition to walking or running, we encourage you to raise funds in support of the Canadian Diabetes Association. These funds will be used to support Canada’s most renowned scientists and clinicians in their quest for new and innovative developments in the prevention, treatment, and management of diabetes.

Although the research is diverse in its scope, the key aspects remain the same – to improve the quality of life of people living with diabetes and to fi nd a cure.

Fundraising Incentive Prizes!

All participants receive a t-shirt. Collect donations to be eligible for one of the following prizes!*

• Raise $125 Receive a Freedom Run Running Buff

• Raise $250 Receive a Freedom Run Sports Pouch

• Raise $500 Receive a Freedom Run Backpack

• Raise $1000 Receive an iPod Shuffl e

* The Canadian Diabetes Association reserves the right to substitute prizes of equal or greater value.

For more information, please visit www.thefreedomrun.ca or call 1-800-BANTING (226-8464)

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Walk or Run! Family Fun! Prizes! Refreshments!

3K Family Fun Walk and 5K Walk or Runwww.thefreedomrun.ca

2013 Locations and DatesBritish ColumbiaNanaimo, Westwood Lake Park September 8Burnaby, Deer Lake Park September 8Prince George, Fort George Park September 22Victoria, Beaver Lake/Elk Lake Park September 22

Alberta Grande Prairie, Muskoseepi Park September 8Red Deer, Heritage Ranch September 22Fort McMurray, Birchwood Trails September 28

Ontario St. Catharines, Grantham Lions Park September 7Peterborough, Rotary Greenway Trail September 7Thunder Bay, Boulevard Lake Park September 8Whitby, Heydenshore Park September 8Brantford, Waterworks Park September 21Barrie, Centennial Park September 22London, Greenway Park September 22Hamilton, Bayfront Park September 28Cornwall, Gray’s Creek Conservation Area September 28Waterloo, Waterloo Park September 29

New BrunswickMoncton, Mapleton Park and Lodge September 22Fredericton, Killarney Lake Park October 20

Nova ScotiaSydney, Petersfi eld Provincial Park September 22

NewfoundlandSt. John’s, Quidi Vidi Lake September 22

Freedom Runs for Diabetes Research are also being offered in the following locations: Charlottetown, Oakville, Winnipeg, Regina, Saskatoon, and Halifax. For more information on each event, please visit www.thefreedomrun.ca

Donation Form• Please sign the back of any cheques made out in your name• Please only include donors for whom you are currently submitting funds• Donations over $15 will receive tax receipts for income tax purposes• Please do not mail cash – cheques, money orders, credit card information

are accepted in place of cash. Make cheques payable to The Canadian Diabetes Association.

Thank you for your support and see you at the event!

Run date: Run location:

Name:

Phone:

Address: Associate: ¨

City: Prov.: PC: Branch #:

Email:

Name of donor Please print clearly and in full or tax receipt may not be issued Phone number Donation Amount submitted

Tax receipt required?

Cheque # or credit card # and expiry dateAddress City Prov PC

John Sample 1234 Main Street Runville ON M1B 3X2 123-456-7890 $100.00 Yes Cheque #123

Fundraising money/miscellaneous cash donations not requiring a receipt $

Total donations remitted $

Mail collected donations to:Canadian Diabetes Association, c/o The Freedom Run 1400 – 522 University AvenueToronto, ON M5G 2R5

Questions: Contact Caitlin at info@thefreedomrun.ca or 1-800-226-8464 ext. 7067

thefreedomrun.ca | 1-800-BANTING

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Participant Waiver Waiver and Release I know that running/walking a road race is a potentially hazardous ac-tivity. I should not enter and run/walk unless I am medically able and properly trained. I real-ize that the event is physically strenuous; that there may be adverse weather conditions and that there may be vehicles present on the course and at intersections. I nevertheless, wish to compete and assume any and all risks associated with running/walking this event including but not limited to falls, contact with other participants, the effects of weather including heat and/or humidity, the conditions of the roads and the presence of traffi c, all such risks being known and appreciated by me. Knowing these facts in consideration of your accepting my entry, I hereby for myself, or for anyone else who may claim on my behalf agree not to sue and waive, release and discharge all persons participating in the operation of this event including without limitations: The Canadian Diabetes Association, Cash Store Financial, The Race Director, all sponsors, their successors and any and all personnel whether volunteer or otherwise, acting on their behalf (the Releasees) for any and all claims, demands, cause of action, damages, or injuries, whether caused by negligence of the Releasees, or by any other cause, which may arise as a result of, or out of my participation in this event. I also indemnify and hold harmless the Releasees from any liability incurred by them and caused by myself. I attest that I am physically fi t, and suffi ciently trained for this event. I hereby grant permission for the use of my likeness participating in this event without obligation or compensation to me. As part of the Waiver and Release, I acknowledge that I have read and understand all of the above.

Signature of participant or parent or guardian required if the entrant is under 18 years of age.

Print name

The Canadian Diabetes Association sincerely thanks everyone including our

volunteers, sponsors, donors and participants.

The Cash Store Financial Freedom Run for Diabetes Research is a great way to spend time with friends and family while raising money for

diabetes. The money raised helps the Association lead the fi ght against diabetes by helping people

with diabetes live healthy lives while we work to fi nd a cure.

Thank you for registering for the

Charitable Number 11883 0744 RR0001