Berry Dairy Days Runs

 Click this link: Printable Registration Form

for a printable form in Microsoft Word.  If you can't open it, please just print this entire page and mail it in.  Please make checks payable to: Nookachamps Winter Runs. Mail entry to: Berry Dairy Days Runs, 1065 Chuckanut Drive, WA 98229

 

2010 Berry Dairy Days Runs

________________________     __________________________                 
Last Name                                                 First Name

____________________________________________________             
Address—Street, City, State, Zip
 
___________________________    ______________________         
Day Phone w/ Area Code                             Birthdate
               
___________________________    _____________________
Age – Day of Race                                           Sex (M/F)

 

Email Address:________________________________________     

Race:   _____1/2 marathon     _____10K        _____2 Mile

Race Fees—Check One

This is for race fee only. DOES NOT INCLUDE FEE FOR T-Shirt.  Additional cost for T-Shirt is listed below.

Pre-registered—received by June 15th:

1/2 Marathon:              $30      _______         

10  Kilometer:             $15      _______   

2    Mile:                      $10      _______   

After June 15th or Day of Race:

1/2 Marathon:            $35      _______         

10  Kilometer:            $20      _______   

2    Mile:                     $15      _______   

12 and Under: Free

Entry Fee is non-refundable and non-transferable

Make Checks Payable to: Berry Dairy Days Runs

************************************************

Short Sleeve T-Shirt:                 $15      _______        

Adult Size: ___S          ___M          ___L          ___XL          ___XXL

Make Checks Payable to: Berry Dairy Days Runs

2010 Berry Dairy Days Runs

MANDATORY WAIVER & RELEASE

I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained.  I agree and abide by any decision of a race official relative to my ability to safely complete the run.  I assume all risks associated with running in this event including, but not limited to falls, contact with other participants, the effects of the weather including high heat, and/or humidity, traffic and the conditions of the road, all such risk being known and appreciated by me.  Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Berry Dairy Days Runs, Skagit Runners, Kevin Ryan, Chris Whan, Bellingham Running Company, Skagit Running Company, The City of Burlington, Skagit Valley College, Skagit County, Washington State Department of Transportation, and all other Berry Dairy Days Runs sponsors and suppliers, and all representatives and successors of the foregoing from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  I grant permission for all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.  I have read the attached announcement, agree to be bound by its provisions including, but not limited to the non-refundability and non-transferability of the entry fee, and certify that the information filled into this form is true and correct.  A parent or legal guardian signing for a participant under 18 years of age further agrees as follows:  I certify that my child has permission to compete in this event, is in good physical condition, and that event officials may authorize necessary emergency treatment.

_____________________________________          ______________
Signature of Participant                                               Date

_____________________________________          ______________
Signature of Guardian if participant is under 18                 Date