RUN FOR THE MOUNTAIN REGISTRATION FORM

Registration form MUST be signed by all runners and hikers to enter.  Pre-registration is requested.  In-person registration can be made at REI, 306 Lawrence Street, Eugene.  Or you can print this form, complete it and then mail your registration and fee to Lane County Parks, 90064 Coburg Road, Eugene, OR 97408.  You can pick up your race packet at REI on either Thursday, June 3rd or Friday, June 4th from 10:00 a.m. to 9:00 p.m.   The 5K run begins at 9:00 a.m. and the 1 mile walk begins at 9:15 a.m. on Saturday, June 5, 2004.

Registration Costs:

Early Registration (by May 21st) with a T-shirt . . . . . . . . . . . $18.00

Early Registration (by May 21st) without a T-shirt . . . . . . . . . $13.00

Day of Race Registration with a T-shirt . . . . . . . . . . . . . . . . $20.00

Day of Race Registration without a T-shirt . . . . . . . . . . . . . . $15.00

Friend of the Mountain . . . . . . . . . . . . . . . . . . . . . . . . . . . . $10.00*

Please make checks payable to: Lane County Parks

Name:  ______________________________________________________________

Address: _____________________________________________________________

____________________________________________________________________

Phone: ____________________________	M/F: ________________________
E-mail Address: ___________________________	Age on June 5, 2004: ___________

Shirt Size (Circle One):   S    M    L    XL

5K Trail Run: ______         1M Trail Hike: ______ 

BECOME A FRIEND OF THE MOUNTAIN!
*Add $10 to the above registration fee, get your registration form and your payment in to REI or the Lane County Parks office by May 21, 2004, and your name will be printed on the back of the T-shirt!	Name (as it should appear on the T-shirt):      ________________________________

MANDATORY WAIVER (Please sign below.) I know that a race/walk event is a potentially hazardous activity. I should not enter and participate in this event unless I am medically able and properly trained and have sufficient stamina to safely and successfully complete this event without harm or injury to myself. In consideration of the acceptance of my entry, I, for myself, my heirs, executors, administrators and assigns, waive, release and discharge any and all rights and claims for damages against the race director, sponsors, race officials, Lane County, its commissioners, agents, officers, and employees, and any and all participating sponsors, supporters, hosts, volunteers, directors, officers, employees and agents of such parties for all claims of damages, demands, actions whatsoever in any manner arising or resulting from my participation in said race. I attest and verify that I have full knowledge of the risk involved in this race, that I assume those risks, that I will assume and pay my own medical and emergency expenses in the event of accident, illness and other incapacity, regardless of whether I have authorized such expenses. I grant permission to all the foregoing the use of any photographs, motion pictures, recording, or any other record of the event for any legitimate purpose. I, also, understand that the entry fee is nonrefundable. I have read the entry information provided and certify my compliance by my signature below.

Signature:_______________________________________

Date:__________________________

Parent:_________________________________________________________            (If under 18, a parent must sign)

Public Works     Parks         Back