Kettle Foods Klassic

Kettle Foods New Years Day Klassic - 2003 Official Entry Form
Only one entrant per form    (Please Print Clearly)

PLEASE CHECK: |_| Mile    |_| Mile Racewalk    |_| Children's 1K    |_| 3K
       $8 per entrant or $30 for family of 4 or more.
       LATE FEE (after 12/30) Add $2 for individual or $5 for family
Long Sleeve Shirt Size: Adult |_|S |_|M |_|L |_|XL (add $14 for shirt)
       Total Enclosed $_________

First Name _________________ Last Name _________________
Age (on 1/1/03) _____ Sex |_| M |_|F
Street Address _____________________ City, State, Zip ___________________
Day Phone # (_____)______________
e-mail: ______________________ e-mail results: |_| Yes|_| No

RELEASE
I personally assume all risks incident to my participation in the 2003 Kettle Foods New Years Day Klassic including, but not limited to, use of facilities, the use of the 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 Kettle Foods, Gallagher Fitness Resources, the City of Salem, the Salem Family YMCA, Spiridon Race Mgmt, Active.com and any other sponsors not mentioned from any and all claims, demands, action, or causes of action incident to my participation in this event. I also understand that the entry fee is non-refundable and that race mementos are guaranteed only to those who pre-register and pick up their materials prior to the event. I grant permission to all the foregoing to use any photographs, motion pictures, video, or any other record of this event for any legitimate purpose.

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

Payment must accompany application payable to:
Kettle Foods Klassic
135 Commercial St. NE Salem, OR 97301

MUST BE RECEIVED BY 12/30/02