Entry Form
Firecracker Marathon, Footraces, Triathlon/Duathlon & Kids races - July 3, 2010
Mail completed entry form and fee to: Firecracker Marathon, Footraces, Triathlon/Duathlon & Kids races, @ Kristina Salazar, 9435 180th Way, SW, Rochester, Wa 98579, Elma, WA
(Please print)

Name (first)                           (last)
|__|__|__|__|__|__|__|__|__|__|__|__|  |__|__|__|__|__|__|__|__|__|__|__|__|
Address
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
City                                   State         Zip
|__|__|__|__|__|__|__|__|__|__|__|__| |__|__| |__|__|__|__|__|
Phone                                      Sex        Age on Race Day
|__|__|__| |__|__|__| |__|__|__|__|       M    F         |__|__|

FEES: (You must order a shirt to receive one):
Triathlon (Before May 20)         $45.00  $ ______
Triathlon (Before June 15)        $50.00  $ ______
Triathlon (Before July 3)         $55.00  $ ______
Triathlon day of race             $60.00  $ ______
Duathlon  (Before May 20)         $30.00  $ ______
Duathlon  (Before June 15)        $35.00  $ ______
Duathlon  (Before July 3)         $40.00  $ ______
Duathlon day of race              $45.00  $ ______
Kids race (Before July 3)         $15.00  $ ______
Kids race day of race             $18.00  $ ______
Marathon  (Before May 20)         $50.00  $ ______
Marathon  (Before June 15)        $55.00  $ ______
Marathon  (Before July 3)         $65.00  $ ______
Marathon day of race              $70.00  $ ______
Half-Marathon (Before May 20)     $35.00  $ ______
Half-marathon (Before June 15)    $40.00  $ ______
Half-marathon (Before July 3)     $45.00  $ ______
Half-marathon day of race         $50.00  $ ______
10 miles (Before June 15)         $25.00  $ ______
10 miles (Before July 3)          $30.00  $ ______
10 miles day of race              $35.00  $ ______
10K (6.2 miles) (Before June 15)  $15.00  $ ______
10K (6.2 miles) (Before July 3)   $20.00  $ ______
10K day of race                   $25.00  $ ______
5K (3.1 miles)  (Before June 15)  $15.00  $ ______
5K              (Before July 3)   $20.00  $ ______
5K day of race                    $25.00  $ ______
1 mile fun run (Before July 3)    $12.00  $ ______
1 mile day of race                $15.00  $ ______
         Short sleeve shirt        $5.00  $ ______
         Long sleeve shirt        $10.00  $ ______
         Tank top                 $10.00  $ ______
         Sweatshirt               $15.00  $ ______
         Hooded sweat             $20.00  $ ______
         Poly/cotton short sleeve $10.00  $ ______
         Poly/cotton long sleeve  $15.00  $ ______
         Marathon maniacs #_____ -$10.00  $ ______
         Half-marathon maniacs ___-$5.00  $ ______

T-shirt Size (circle one): 
Adult S  M  L  XL   XXL
Child S  M  L  XL   XXL

TOTAL ENCLOSED                            $ ______

MAKE CHECK PAYABLE TO: Kristina Salazar, 9435 180th Way, SW, Rochester, Wa 98579.

Waiver I HEREBY RELEASE THE PUGET SOUND CRUISERS, CITY OF ELMA, COUNTY OF GRAYS HARBOR, VANCE CREEK PARK, STATE OF WASHINGTON, EMPLOYEES, VOLUNTEERS, OR ANY ONE ELSE INVOLVED IN THE ABOVE EVENTS. I KNOW BY SIGNING THIS FORM, I'M WAIVING MY RIGHT TO SUE FOR ANY AND ALL REAS ONS, INCLUDING BUT NOT LIMITED TO PERSONAL INJURY OR DEATH. I HAVE TRAINED FOR THIS EVENT AND HAVE NO MEDICAL PROBLEMS OF ANY TYPE. I KNOW MY ENTRY FEE IS NON-REFUNDABLE NO MATTER WHAT THE REASON AND I WILL NO ASK FOR IT BACK. THE DECISION OF THE RACE DIRECTOR IS FINAL!!

__________________________________________________________________
Signature of Athlete Date (Signature of Parent or Guardian if under 18 years)

For more information call 360-480-5981 or wanttoduit@hotmail.com

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