Make Checks Payable to: Rhody Run
Mail to:
AA Sports, Ltd
4840 SW Western Ave. Suite 400
Beaverton, Oregon 97005

EVENT (all entries include short-sleeved T-shirt):

- 12K Run/Walk - $25 if received on or before 5/8 12K Run/Walk - $40 if received after 5/8 / Day of race Ages 15 & Under Run/Walk - $10 if received on or before 5/8 Ages 15 & Under Run/Walk - $20 if received after 5/8 / Day of race

First Name / MI / Last Name

ChampionChip Number (if applicable - Example - CE12345)

Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy (birth year not 2008)

Age

Gender
- Female Male
Phone

Email

Division (Individual)
- 12 years & under 13 - 15 years 16 - 18 years 19 - 24 years 25 - 29 years 30 - 34 years 35 - 39 years 40 - 44 years 45 - 49 years 50 - 54 years 55 - 59 years 60 - 64 years 65 - 69 years 70 - 74 years 75 - 79 years 80 years & over
T-Shirt Size (included with race entry fee)
- YS (ages 6 - 9) YM (ages 10 - 12) S- Adult M - Adult L - Adult XL - Adult XXL - Adult

Check#

Amount Enclosed


WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
WAIVER & RELEASE: READ THIS! 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 to 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, and the effects of the weather including high heat and/or humidity, traffic and the conditions of the road, all such risks 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 Port Townsend Marathon Association, Fort Worden State Park, City of Port Townsend, Jefferson County, AA Sports, Ltd., Penrose Photography, Port Townsend School of Massage, Jefferson County Family YMCA, Bagel Haven, Port Townsend Brewing Company, Subway, SOS Printing, Port Townsend Foundry, OlympusNet, McDonald Insurance, Port Townsend & Jefferson County Leader, Sport Townsend, DM Disposal, KitsapBank, Little & Little Construction, Safeway, all other Rhody Run 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 of 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 it's provisions including but not limited to the non-refundable 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. I agree to return the Timing Chip assigned to me or pay a $30.00 replacement fee.

Type Full Name


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

Date________________________________________