Run for the Cheetah Entry Form
Sunday, March 28, 2010
Portland International Raceway (PIR) - NEW LOCATION FOR 2010
5k & 8k Run/Walk, Kids' Dash

Website - www.runforthecheetah.org/portland

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:
CCF / Run for the Cheetah

Mail to:
AA Sports, Ltd.
4836 SW Western Ave
Beaverton, OR 97005


Event - Choose One


I would like to purchase a 1-year membership to the CCF ($25.00)

I would like to make a donation to the CCF:

IF YES, PLEASE ENTER DONATION AMOUNT

First Name / MI / Last Name

Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy

Age

Gender

Phone

Email

Division (Individuals)

OPTIONAL DIVISIONS (the following are optional otherwise will compete in age division):

ADULT T-SHIRTS (after March 22 limited to stock on hand):

KID'S DASH T-SHIRTS (after March 22 limited to stock on hand):

Check#

Amount Enclosed (including donations)



WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I know that participating in an organized athletic event is potentially hazardous, and that I should not enter to participate unless I am medically able and properly trained. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am physically fit and that I have sufficiently trained. I agree to abide by the competitive rules. I hereby take the following action for myself, my executors, administrators, heirs, next to kin, successors and assigns, or anyone else who might claim or sue on my behalf, and I hereby waive, release and discharge from any and all claims, losses, or liabilities for death, personal injury, partial or permanent disability, property damage, medical or hospital bills, or theft which may arise out of or relate to my participation in this event. I agree not to sue, and to hold harmless any and all persons, sponsors, volunteers, participants or government agencies for any and all claims or liabilities that I have waived, released or discharges herein. I understand that the Entry Fees are Non-Refundable/Non-Transferable.

Type Full Name


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

Date________________________________________