Address: _______________________________________________________

City: ______________________ State: ________ Zip:__________________

Telephone: ________________________ E-Mail: _____________________

WAIVER: I know that walking a roadrace, regardless of the distance, is a potentially hazardous activity. I should not enter and participate unless I am medically able and properly trained. I assume any and all risks associated with running this event including but not limited to falls, contact with other participants, the effects of the weather, and the condition of the road, all such risks being known and appreciated by me.

Knowing these facts, and in consideration of your accepting my entry, I herby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf covenant not to sue, and waive, release and discharge Racewalkers Northwest, the City of Portland, County of Multnomah, the Race Officials, volunteers, any and all sponsors including their agents, employees, assigns or anyone acting for or on their behalf from any and all claims of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of or in the course of my participation in this event. I hereby consent to permit emergency treatment in the event of injury or illness.

This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The undersigned further grants full permission to Racewalkers Northwest and/or agents authorized by them to use any photographs, videotapes, recording or any othe record of this event for any purpose.

Signature: _____________________________________________________

Marie VerMeer, Race Director

1739 NE 120th Ave.

Portland, OR 97220