Olivia Medici Memorial 5K RUN/WALK Entry Form
Sunday, April 27, 2008 - 8:45 AM
Greenway Park/Fanno Farmhouse, Beaverton, Oregon
10K Run (6.2-Miles) & 5K Run/Walk (3.1-Miles)
Website - www.oliviaswish.com

Official Use Only

Instructions
> Type in your information in the blanks provided.
> Print entry form & SIGN WAIVER (Entry will not be accepted without the signed waiver)
> Make Checks Payable to:
The Olivia School

Mail to:
Olivia Medici Memorial Run
11455 SW Gallo Ave
Tigard, OR 97223


Event - Choose One (entry includes: T-shirt (adult entry only) - T-shirts guaranteed to those registered by April 21st.


First Name / MI / Last Name

Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy (birth year not 2009)

Age

Gender

Phone

Email

T-Shirt Size (entry includes 100% cotton short Sleeved T)

I would like to make a donation to the Olivia's Wish Organization in the amount of:

Check#

Amount Enclosed



WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I hereby release and discharge The Olivia Medici Memorial Run, Tualatin Hills Parks and Recreation District, PS Business Parks, Rivermark Community Credit Union, the City of Beaverton, all sponsors, and coordinators from all claims of damage, demands, and actions in any manner growing out of my participation in the event. I further attest I am physically qualified to participate in this event, and understand that weather and ground conditions may be hazardous. I give me permission to use, without limitation or obligation, photographs, audiotape, or audio recordings that may include my image or voice for the purposes of promotion for The Olivia Medici Memorial Run and its sponsors. I waive and release any and all claims for damages against the hosts, sponsoring organization and coordinators for any and all injuries sustained while participation in The Olivia Medici Memorial Run, and accept full responsibility for participation. By my signature, I hereby acknowledge reading and understanding the implications of this clause. The Entry Fee is Non-Refundable/Non-Transferable. I also agree to return the ChampionChip timing devise assigned to me or to pay a $30 replacement fee.

Type Full Name


Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)

Date________________________________________