PLEASE MAIL FORM BEFORE FRIDAY OCTOBER 10TH

Instructions: Type in your information in the blanks provided. (that's right, you can actually type it in!!!)
Print entry form & SIGN WAIVER (Entry will not be accepted without the signed waiver)
Make Checks Payable and mail to: Terrapin Events • PO Box 15257 • Portland, OR • 97293

ENTRY (Choose One) REGISTRATION MUST BE RECEIVED BEFORE OCTOBER 1ST TO PURCHASE A TECH SHIRT

5K RUN / WALK (WITHOUT SHIRT)
      $15 BEFORE OCT 1ST
      $20 OCT 1ST UNTIL SAT PACKET PICKUP
      $25 PACKET PICKUP AND DAY OF RACE		 5K RUN / WALK (WITH COTTON SHIRT)
      $25 BEFORE OCT 1ST
      $30 OCT 1ST UNTIL SAT PACKET PICKUP
      $35 PACKET PICKUP AND DAY OF RACE 		$35 5K RUN / WALK (WITH TECH SHIRT)
      ONLY AVAILABLE BEFORE OCT. 1ST
10K RUN / WALK (WITHOUT SHIRT)
      $15 BEFORE OCT 1ST
      $20 OCT 1ST UNTIL SAT PACKET PICKUP
      $25 PACKET PICKUP AND DAY OF RACE 		10K RUN / WALK (WITH COTTON SHIRT)
      $25 BEFORE OCT 1ST
      $30 OCT 1ST UNTIL SAT PACKET PICKUP
      $35 PACKET PICKUP AND DAY OF RACE 		$35 10K RUN / WALK (WITH TECH SHIRT)
      ONLY AVAILABLE BEFORE OCT. 1ST
1/2 MARATHON RUN / WALK (W/ COTTON SHIRT)
      $45 BEFORE OCT 1ST
      $50 OCT 1ST UNTIL SAT PACKET PICKUP
      $60 PACKET PICKUP AND DAY OF RACE 		$55 1/2 MARATHON RUN / WALK (W/ TECH SHIRT)
      ONLY AVAILABLE BEFORE OCT. 1ST		  
1/2 MILE KIDS DASH (WITH COTTON SHIRT)
        $10		    

PARTICIPANT INFO:
 First Name / MI / Last Name

Street Address                                                                                               City
  
State/Province                                                    Zip/Postal Code

Phone

Birthdate - mm/dd/yy                 Gender

Email (non-business)

T-Shirts Size (add 2.00 for XXL)


Amount Enclosed


WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I know that running/walking a road race is a potentially hazardous activity. I should not enter and run/walk 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/walk. I assume all risks associated with participating in this event including, but not limited to falls, contact with other participants, the effects of weather, including high 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 acceptance of my entry, I for myself and anyone entitled to act on my behalf, waive and release Terrapin Events, City of Portland, State of Oregon (ODOT), and any and all persons, sponsors and entities, their representatives and successors from all claims or liabilities of any kind arising out of my participation even though said liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission for all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. Parents must sign if participant is under 18 years of age. This is to certify that my child has permission to complete in this event, is in good physical condition and that event officials may authorize necessary emergency treatment. ENTRY FEES ARE NON-REFUNDABLE.

Signature X _____________________________________________________ Date_____________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)