OFFICE USE ONLY: __ POS __ AS __ CC

TEAM GFR Training Registration Form 2012-2013 ~ 26.2 ~ 13.1 ~ 10k ~ 5k ~ Relay

Complete and bring or mail with check (payable to GFR) to:
Gallagher Fitness Resources
135 Commercial St NE, Salem, OR 97301

My Goal Event(s): ___________________________________ ___________________________________

Please Circle Plan Price: New Alum D1: Nov-Oct (12 mo) by 11/24/12 $250 $200 D2: Nov-Jun (8 mo) by 11/24/12 $200 $160 D3: Nov-Apr (6 mo) by 11/24/12 $165 $135 D4: 26.2 Plan Only (22 wks) $150 $120 D5: 13.1 Plan Only (13 wks) $100 $80 D6: Relay Plan Only (13 wks) $100 $80 D7: 10k Plan Only (10 wks) $85 $70 D8: 5k Plan Only (10 wks) $85 $70

Please Print Clearly Name: ___________________________________________________ Address: _________________________________________________ City: ____________________________________ Zip: ____________ E-mail: ___________________________________________________ Day Phone: _________________ Cell Phone: ________________ Emergency Contact: ________________________________________ Emergency Phone: _________________________________________

WAIVER:
I know that walking, running, and road racing are potentially hazardous activities. By entering this training program I am taking responsibility for medical clearance and for being physically able and properly trained to participate in this program. I have consulted with my physician or primary health care provider. I agree to abide by any decision of program officials relative to my ability to safely complete the training program. I assume all risks associated with running, but not limited to my own fitness and health condition. I acknowledge the effects of weather, including cold, windy conditions, rain, high heat and/or humidity, or that falls, contact with other participants, the condition of sidewalks and/or roads, and possible traffic on the route, are all risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my application, I for myself and anyone entitled to act on my behalf, waive and release Gallagher Fitness Resources, GFR Inc, and all other sponsors, program officials, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these activities even though that liability may arise out of negligence or carelessness on the persons named in this waiver and other organizations. I grant permission to GFR, Inc. to use any photographs, video, or any other record of this program for any legitimate purpose. I understand that bicycles, skateboards, baby joggers, roller blades, and audio headsets are not allowed in this training program and I will abide by this guideline. I understand that registration is non-refundable once it has been received.

Signature: _____________________________________ Date: _____________________