The 2004 Arc of Oregon Spring Splash

	Sponsor's Name	Sponsor's Address	Donation Amount	Amount Collected
1
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5
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12	Company matching donation
		TOTAL

The Arc of Oregon Spring Splash
OFFICIAL ENTRY FORM - Only ONE entrant per form    (Please Print Clearly)

PLEASE CHECK: |_| 8k    |_| 5k Walk/Run    |_| Children's 1K   
TEAM CHALLENGE NAME __________________________________________________
       $8 per entrant or $35 for family of 4 or more.
       LATE FEE (after 4/2) Add $2 or $5 for family
Shirt Size: Youth |_|S |_|M |_|L (Add $13) OR Adult |_|S |_|M |_|L |_|XL (Add $13)
       Total Enclosed $_________

First Name _________________ Last Name _________________

Age (on 4/04/04) _____ 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 2004 The Arc of Oregon Spring Splash Events 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 West Coast Bank, Gallagher Fitness Resources, Asics Tiger Corp, the City of Salem, The Hoop, Spiridon Race Mgmt 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:
The Arc of Oregon Spring Splash
135 Commercial St. NE Salem, OR 97301
MUST BE RECEIVED BY 4/2/04