THE OFFICIAL EVENT REGISTRATION APPLICATION FORM
Welcome to the 4th Annual Pacific Run/Walk For The Poor Trail ½ Marathon Benefit Distances are: One Mile Youth, 5k, 10k, and ½ Marathon 9/27/08 Ft Steilacoom Park Main Mx Facility,Start Time: 9am
Please make check payable to: Washington State Trail Running, Walking and Duathlon Club, 9/27/08, POB #39623, Lakewood, WA 98499
PLEASE PRINT YOUR INFORMATION CLEARLY – THANK YOU. PHOTO COPYING IS PERMITTED TO SAVE TIME AND CONVENIENCE
Date Recvd: __________
Date Processed: _________
Official Race Bib Number: ____________
LAST NAME: _______________________; FIRST NAME: _______________; MI: ______ ADDRESS: ___________________________________________; CITY: _________________ STATE: _________; ZIP CODE: _____________________ YOUR DAY TIME #: ____________________________, YOU’RE EVENING #: _____________________
DATE OF BIRTH: _____________________________; AGE ON RACE DAY: _______________________ PLEASE CIRCLE AGE DIVISIONS: 10 and Under; 11-15; 16-19; 20-29; 30-39; 40-49; 50-59; 60-69; 70-79; 80+ and CLYEDALE / ATHENA EMERGENCY CONTACT#: _________________________________ PLEASE EMAIL ME THE EVENT RESULTS TO: __________________________________________________ COUNTRY: _________________________________; CITIZENSHIP: _______________________________ SEX: _________MALE; ________FEMALE ADULT EVENT T-SHIRT SIZE: ____________________; YOUTH EVENT T-SHIRT SIZE: ___________ CLUB AFFILIATION(S): _____________________________________; MEMBERSHIP #: _____________ EDUCATIONAL LEVEL: __________________________________ OPTIONAL OCCUPATION: ___________________________________________ OPTIONAL EXPECTED FINISHING TIME: ______________________________ Be Honest PLEASE INDICATE WHICH RACE DISTANCE YOU WILL PURSUE: ____Youth: One Mile ______5k Run/Walk ________10k Run/Walk _______ ½ MARATHON RUN/WALK
NOTE: SAME DAY RACE PARTICIPANTS CAN EXPECT A 3 – 4 WEEK DELAY IN RECEIVING YOUR EVENT TSHIRT. SO DON’T PROCRASTINATE, REGISTER EARLY TO AVOID THE DELAY. THE EVENT T-SHIRTS WILL BE LIMITED ON RACE DAY. ALL T-SHIRTS DISTRIBUTED TO PARTICIPANTS WILL BE ON A FIRST COME,
FIRST SERVE BASIS. ALL PRE-REGISTERED PARTICIPANTS T-SHIRT WILL BE INCLUDED IN YOUR EVENT RACE GOODIE BAG LOCATED AT THE EVENT REGISTRATION TABLE.
Official Event Hold Harmless/Waiver Statement
I UNDERSTAND THAT MY ENTRY FEES ARE NON-REFUNDABLE AND BIB NUMBER IS NONTRANSFERABLE. THIS IS AN IMPORTANT LEGAL DOCUMENT. PLEASE READ CAREFULLY BEFORE SIGNING THIS EVENT WAIVER. NO REFUND POLICY APPLY. I know that trail running or walking are known and potentially hazardous activities. I should not enter and participate unless I am medically able and properly trained. I agree to abide by any decision of the race officials relative to my ability to safely complete this event. I assume all risks associated with the 4th ANNUAL RUN/WALK FOR THE POOR TRAIL ½ MARATHON BENEFIT including, but not limited to falls, contact with other participants, the effects of weather, including northwest weather changes, getting lost, daydreaming on established course, making contact with other park users, the conditions of the trails and pathways on the course. I know the risks involved in this event. (Some prescriptions and over-the-counter medications contain banned substances. Information regarding drugs and drug test may be obtained by calling the USOC Drug Hotline at 1-800-233-0393). Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself, and anyone entitled to act on my behalf, waive and release all the event, the event directors, Washington State Trail Running, Walking and Duathlon Club members, City of Lakewood, Pierce College and all sponsors, their representatives, and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the person(s) name in this waiver. Further, I hereby grant full permission to any and all of the foregoing to use my name, my voice, and/or my picture in any broadcast, telecast advertising, promotion, or other account of this event for any purposes whatsoever. This event may be covered by the media. This event is Road Runners Club of America (RRCA) sanctioned. Club/Race management reserves the right to reject any entry and further reserved the right to change the information of the abovereferenced event without prior notice. _________________________________________________________________________________________________
Date/Sign, I am at least 18 years of age and have read and understand the above waiver.
Date/Sign, I am under 18 years of age. My parent(s) or legal guardian has read and understands all the above and is signing this documents. He/she consents to my participation in the distance I have selected.
We RECOMMEND YOU REGISTER ONLINE @ www.active.com or www.humanmultisportspnw.org. You may request the event registration form via email @ humansports2001@yahoo.com
Cost to Participate
______, Youth Ages 17 and Under is $15.00
_____, Ages 18 thru 99, Early Bird up to 8/31/08 = $35.00 _____, Ages 18 thru 99, up to 9/26//08 = $40.00 _____, Ages 18 thru 99, Same-Day-Race 9/27/08 = $45.00
Participant(s) registration includes event goodie bags, event t-shirt, bib number, mystery prizes and awards for overall in each distance and age group divisions. Come Join The Club For Fun, Fitness and Friendship
afd: 9/27/08 event forms, 8/12/08 dl