TEAM GFR MARATHON TRAINING REGISTRATION FORM

OFFICE USE ONLY: __ ActiveSalem __ POS __ Survey __ T-shirt __ Forum Login __ CC

Choose Session

26 Weeks-B [4/27/08-10/25/08]	__$150
13 Weeks-C [6/1/08-8/30/08]	__$110

Name: _________________________________________________________

Address: _______________________________________________________

City: ________________________________________ Zip: ______________

E-mail: _________________________________________________________

Day Phone: ____________________ Evening Phone: ___________________

T-shirt: Women's __S __M __L __XL -OR- Men's __S __M __L __XL __2XL

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, the City of Salem, 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 Gallagher Fitness Resources and all of the foregoing to use any photographs, motion pictures, video, recordings, or any other record of this program for any legitimate purpose. I also understand that bicycles, skateboards, baby joggers, roller skates or blades, and audio headsets are not allowed in this training program and I will abide by this guideline. I also understand that registration is non-refundable once it has been received.

Signature: _____________________________________ Date: _____________________ Amount: _________