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.
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
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