REGISTRATION FORM
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Newport Half-Marathon 2010 Registration Form
Saturday, SEPTEMBER 18, 2010 - 8:30 a.m.
A Benefit for the Friends of The Oregon Coast Aquatic Center See: www.swimocac.org
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Name: ___________________ , ____________________ ___ Sex: M[ ] F[ ]
Last First M.I.
Street ______________________________________________
City ____________________________ State/Prov ____________________
Zip Code __________ Country _________________________
Telephone# _________________ Email Address ___________________________
1/2Marathon Run ( ) 1/2Marathon Walk ( ) 1/2Marathon Bike ( ) 10 Mile Run ( )
4 person relay run ( ) 4 person relay walk ( ) 4 person relay bike ( ) 4 person 10 mile ( )
Names of Relay Team: __________ __________ __________ __________
Age(s) on Race Day ______
Course map at www.swimocac.org Start 8:30 at Newport High School; end at Nye Beach Parking (shuttle available)
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Send payment with registration to:
FOCAP
550 SE 123rd St.
South Beach, OR 97366 USA
Total Enclosed: $______________
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Rec'd before August 31, 2010 $35 ( )
Rec'd after Sept 1, 2009 $40 ( )
Kids under 18 - any event $25 ( )
4- person relay team - any event $105 ( )
Absolutely no refunds
Registrations and Fees are not transferable or refundable
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WAIVER OF LIABILITY: In consideration of your accepting this entry, I, the undersigned, intending to be legally bound hereby, for myself, my family, my heirs, executors, and administrators, forever waive, release and discharge any and all rights and claims for damages and causes of suit or action, known or unknown, that I may have against the Newport Half Marathon, The City of Newport, Lincoln County, Oregon State Parks and Recreation Department, any and all political entities, Friends of the Oregon Coast Aquatic Park, all independent contractors and construction firms working on or near the race course, any and all business and residential owners located on the race course, all persons working with or associated with the Newport 1/2 Marathon including but not limited to all committee persons, organizers, race directors and volunteers and sponsors of the 1/ 2 Marathon and any related 1/ 2 Marathon events and their officers, directors, employees, agents and representatives, successors, and assigns for any and all injuries suffered by me in this event. I attest that I am physically fit, am aware of the dangers and precautions that must be taken when running in warm or cold, wet or dry conditions and have sufficiently trained for the completion of this event. I also agree to abide by any decision of an appointed medical official relative to my ability to safely continue or complete the Run/Walk. I further assume and will pay my own medical expenses in the event of an accident, illness, or other incapacity regardless of whether I have authorized such expense. Further I hereby grant full permission to the Newport 1/ 2 Marathon and or agents authorized by them to use any photographs, videotapes, motion pictures, recording or any other record of this event for any legitimate purpose at any time.
I HAVE READ THIS WAIVER CAREFULLY AND UNDERSTAND IT.
Signature __________________________________________________ Date _________________
If under 18, parents signature __________________________________ Date_________________
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