2015 Zena Road Runs Entry Form:

Mailing Address:
Attn: Vicki Hehr
610 Joel Palmer Way
Dayton, OR 97114

(Checks payable to: W.V. R. R)

Race: Entry fee: $15 (through 1/02/15), $20 (1/03/15 - 1/29/15), $25 on DOR

___ 15K   ____ 6mile ____ 3mile

______ WVRR member discount = $3.00

                        ** must order t-shirts by January 16th **

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

Name: (print) ____________________________________

Address: ______________________________________

City:______________ State:_____  Zip:_____________

Phone: _________________

Age: _____ Gender: __M __F Email:________________________

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: