2nd Annual Spring Run Off Registration Form March 3rd, 2012

Shiny Penny Syndrome 5K Run/Walk Registration Form
MCKAY ELEMENTARY SCHOOL 1539 SW 44th St., Pendleton, OR 97801 Race Begins at 9:00 am / Kids Race Begins at 8:30 am Return forms and money to: Shiny Penny Syndrome, 1816 SW 3rd St., Pendleton, OR 97801 Name:_______________________________________ Gender: M or F Age on Race Day:_____ Address:_________________________________________________________________________
Number/Street City State Zip

Email:___________________________________ Phone Number:__________________________
 5K Run/Walk ($10.00 reg. fee)

 Kids Fun Run (12 & Under, $3.00 reg. fee)
M L XL (please circle size)

 $10.00 T-Shirt Size ( pre orders only, must be postmarked by 2/25/2012) : S

Same day registration begins at 8:00 am, Saturday, March 3rd, 2012 at McKay School

Payment Information: (circle one): CASH or CHECK Please make checks out to: Shiny Penny Syndrome
Liability Waiver must be signed to participate in the Shiny Penny Syndrome Spring Run Off 5K Run/Walk. I recognize 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 race officials 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, the effects of the weather, including cold, snow, and/or ice, 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 the organizers of the SPS 5K Run/Walk, its directors, officers, staff, and volunteers, the city of Pendleton, OR and its employees 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. Further, I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose. I ALSO UNDERSTAND THAT THERE ARE NO REFUNDS FOR THIS EVENT.

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Signature of participant or guardian if under 18

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Date

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