2003 Salem Electric Iris 5k Run and Walk

2003 Salem Electric Iris 5k Run and Walk
OFFICIAL ENTRY FORM - Only one entrant per form    (Please Print Clearly)

Individual Entry for 5k Run or Walk $10 -- Family of 4 or more $35.00 (individual forms PLEASE)
       Cotton Iris Fest Shirt ADD $8 - Shirt Size: |_| S |_| M |_| L |_|XL |_|XXL
       LATE FEE: ADD $3 or $12 for Family
       TOTAL AMOUNT ENCLOSED: $___________

|_| 5k run    |_| 5k Walk      Gender Male|_|    Female|_|

First Name _________________ Last Name _________________
Street Address __________________________________
City, State, Zip ________________________________
Age (on 5/17/03) _____ Day Phone # (_____)______________

RELEASE
I personally assume all risks incident to my participation in the Iris Run events including, but not limited to, use of facilities, use of streets, and all hazards from running or walking in this event. I hereby release for myself, my heirs, executors and administrators, all sponsors of this race including Salem Electric, Gallagher Fitness Resuorces, Nike, Keizer Chamber of Commerce, the City of Keizer, Marion County, Spiridon Race Management, and any other sponsors not mentioned from any and all claims, demands, action, or causes of action incident to my participation in these events. I grant permission to all of the foregoing to use any photographs, motion pictures, video, recordings, or any other record of this event for any legitimate purpose. I also understand that the entry fee is non-refundable once payment has been received.

Signed ______________________ Date__________
Parent or guardian _________________________ (if entrant under 18)

Payment must accompany application payable to:
Salem Electric Iris Run
980 Chemawa Rd NE Keizer, OR 97303
MUST BE RECEIVED BY 5/15/03