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2009 Results

Preregistration must be received by Friday, Dec 26th.                            
One entry form for each registrant. Please print NEATLY.

First Name ___________________ M F Age _____
                                              Circle one Age on 1-1-09
Last Name _______________________
D.O.B. ___________

Address _________________________________________
City: __________________

State: ____ Zip: _________
Phone: ________________ Email: ___________________

        Mail to:
Willamette Valley Road Runners
PO Box 4002
Salem, OR 97302

Preregistration Fees
____________ $8.00
____________ $6.00 (2009 WVRR Member)

Optional: Join or Renew WVRR for
2009 & save $2 or more today !
____________ $20 Individual
____________ $30 Family

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OFFICIAL WAIVER: I know that by participating in a road race is a potentially hazardous activity. I should not participate unless I am   medically able and properly trained.
I agree to abide by any decision of a race official relative to my ability to safely complete the event. I assume all risks associated with other participants, the effects of the
weather, including chilling conditions, high heat and/or humidity, traffic and the conditions of the road/trail, all such risks being known and appreciated by me. Having read this |
waiver and knowing these facts and in consideration of your accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release the State of Oregon
(ODOT), Marion County, City of Salem, Willamette Valley Road Runners, and all other sponsors, their representatives and successors 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, motion pictures, video, recordings, or any other record of this event
for any legitimate purpose. Parents must sign if participant is under 18 years of age. I also understand entry fees are non-refundable

SIGNED _____________________________________ DATE ________________________________

____________________________________________
PARENT OR GUARDIAN (if participant is under age 18)