ENTRY FORM--2003 SEATTLE OPEN CROSS COUNTRY CLASSIC
(please print clearly)
Last Name_______________________________________
First Name_______________________________________
Address________________________________________
City___________________State/Province_____ Postal Code_________
Country (if non USA or CANADA)_______________________________
Age on 1/26/03:_______________ Male or Female (circle one)
Phone______________________________
Team affiliation__________________________________________
E-Mail Address_________________________________
Race Entering (circle) M & W 4K W 6K M 10K
WAIVER OF RELEASE (MUST BE SIGNED TO COMPETE): In consideration of your accepting my entry, I, intending to be legally bound for myself, my heirs, executors, and administrators, do hereby release and discharge, Club Ballard Athletics, the Pacific Northwest Association of USA Track & Field, the City of Seattle, and any and all officials, sponsors, and contributors from any and all liability arising from illness, injury, and damages I may suffer as a result of my participation in this event. I also understand that any sponsor may use for publicity of this event, my name and/or pictures of me participating in this event without obligation or liability to me. I have read the entry information provided and certify my compliance by my signature below. I also understand that my entry fee is non-refundable and non-transferrable. I will pay my own medical and emergency expenses in the event I am ill, injured or otherwise incapacitated and treatment is recommended by the event's volunteers. I believe that I am physically fit to participate in this event, and acknowledge my responsibility to seek medical evaluation if I have any doubts about my fitness for this event
Athletes who participate in this competition will be subject to formal drug testing in accordance with USATF rules and IAAF Rule 144. Athletes found positive for banned substances, or who refuse to be tested, will be disqualified from this event, and will lose eligibility for future competitions. Some prescriptions and over-the-counter medications contain banned substances. Information regarding drugs and drug testing may be obtained by calling the USOC Hotline at 1-800-233-0393.
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Participant's Signature_________________________________________________________
Signature of Parent/Guardian if Under 18
__________________________________________
Date _________________
MAKE CHECKS PAYABLE TO:
CLUB BALLARD ATHLETICS, PO Box 70601, Seattle WA 98107-0601 USA
Entry Fee: $10.00 BEFORE 1/21/2003; $15 DAY OF RACE