Race: ____ 15K ($10)    ____ 6 mile ($10)     ____ 3 Mile ($10)
($15 Day of Race)

______ WVRR member discount = $2.00

_____ $20 add: LONG SLEEVED TECH T-SHIRT !
            New this year - first time ever for this race
             ** must order t-shirts by January 20th **

Please circle size (adult sizes) -  XS  SM  MD  LG  XL  XXL

Name: (print) ____________________________________

Address: ______________________________________

City:______________ State:_____  Zip:_____________

Phone: _________________

Age: _____ Sex: __M __F

Email:________________________

Waiver:
I know that running a road race is a potentially hazardous activity. I should not enter and run 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 Run. I assume all risks associated with other participants, the effects of the weather, including high heat and/or
humidity, traffic and the conditions of the road, 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 Polk County, Marion County, the City of Salem, the Willamette Valley Road
Runners, and all other sponsors, their representatives, and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to
all of the foregoing to use any photograph, motion picture, recording, or any other record of this event for any legitimate purpose. I also understand that the entry fee is
non-refundable. No one may enter this event without signing this official waiver!

Signature: __________________________________________________________ Date: ________________________
If under 18 years of age, parent signature required: