Please print and fill out this registration form and bring it with you on race day!
Note: copies will also be available for filling out the day of the race.

Registration Form

Race Day Saturday July 20, 2013   9:00 AM

Race Starts at Whiteaker Soccer Fields Track

$20 Registration on Day of Race Payable by Check or Cash

$10 Registration For Teens Between 13-18 Years of Age

Race Day Registration Begins at 8:30 am & closes at 8:59 am

Runner Name _______________________________________

Gender:  Male    Female     Age _____   (prizes will be awarded by age groupings)

Address ____________________________ City _____________________

State ___________  Zip Code ____________

Email ________________________________________________

I will not enter and participate unless I am medically able and properly trained.  I assume all risks associated with this event, including but not limited to falls, contact with other participants, effects of weather conditions, conditions of the bark dust covered trail, all such risks being known and acknowledged by me.  Having read this waiver and knowing these facts I waive and release the Salem-Keizer School District and Whiteaker Middle School, race officials, volunteers, and all sponsors from all claims and liabilities of any kind arising out of my participation in this event.  I grant permission to all of the foregoing to use any photographs, video or any other record of this event for any legitimate purpose.

Signed _________________________________________________________________

Guardian (if under 18) _____________________________________________________

                                                                                               

Checks made payable to “MMRF” (The Multiple Myeloma Research Foundation)

If you are unable to attend this year’s race your contribution will be most welcome!

Questions:  Please email patriciakathleen5k@gmail.com