Breakaway from Cancer® Champion
Online Submission Form

Each Breakaway from Cancer® Champion will: Lead the Breakaway Mile, a celebratory one mile walk across the finish line of the 2010 Amgen Tour of California prior to the professional finish,  in his or her community: Santa Cruz (May 18), Modesto (May 19), Bakersfield (May 20) and the Conejo Valley (May 23) Participate in jersey presentations at Amgen Tour of California award ceremonies Attend the Breakaway from Cancer® hospitality area at the 2010 Amgen Tour of California Tell your story in a public setting and, potentially, conduct media interviews

Do you know, or are you, a cancer survivor, patient, caregiver or advocate who has made a difference in your community? Someone who is passionate about helping others diagnosed with cancer? Someone who inspires others?

Be sure to nominate that person (or yourself) to be a Breakaway from Cancer® Champion to be honored during the 2010 Amgen Tour of California! 

One winner will be selected from each of four 2010 Amgen Tour of California host city areas (Santa Cruz, Modesto, Bakersfield and the Conejo Valley). 

• Cancer survivor, patient, caregiver or advocate for those impacted by cancer who has made a difference within their community and inspired others
• Resides in 2010 Amgen Tour of California host city community of Santa Cruz, Modesto, Bakersfield or the Conejo Valley (Thousand Oaks, Westlake Village, Agoura Hills)
• Available to be recognized in 2010 Amgen Tour of California events in corresponding host city community – Santa Cruz, May 18; Modesto, May 19; Bakersfield, May 20; Conejo Valley, May 23
• Willing to speak in a public manner about their story/cancer connection and participate in media interviews
• Allow usage of nominee’s name and likeness in all Breakaway from Cancer® collateral and materials, including Website, social media, etc. 

Healthcare professionals and employees of Amgen, AEG, Medalist, Prevent Cancer Foundation, Cancer Support Community, Patient Advocate Foundation and National Coalition for Cancer Survivorship are not eligible.

Judging will be based on positive community impact (50%) and the inspirational nature of the nominee’s story (50%). Judging will be conducted by a committee comprised of Amgen’s Director of Advocacy, AEG Cycling Managing Director, and one leader each from Prevent Cancer Foundation, Cancer Support Community, Patient Advocate Foundation and National Coalition for Cancer Survivorship and one member of each host city Local Organizing Committee.