Columbia River Gorge Marathon & Half Marathon  --  PRINTABLE APPLICATION

Sunday, June 5, 2005     Marathon Start: 7:00 AM     Half Marathon Start: 8:30 AM

Last Name

Early Start: 6:00 AM

First Name

Initial

E-Mail

Mailing Address

City

State

Zip

Country

Waiver:  EVERYONE MUST SIGN

Waiver Statement:  In consideration of the acceptance of my entry, I intending to be legally bound, do hereby for myself and my heirs, executors, and administrators waive and release any and all rights and claims for damages and cases of suit or action, known or unknown, that I have against the Columbia River Gorge Marathon, GorgeMan Events, the city of Hood River, and the Country of Hood River, and Wasco County, and the City of the Dalles, through which the race is routed and all participating race sponsors, directors, officers, employees, volunteers and agents for any and all injuries resulting from my participation in the Columbia River Gorge Marathon held on Sunday, June 5, 2005. I attest that I am physically fit and have sufficiently trained for this event, my physical condition verified by a licensed M.D. during the last six months.  I also grant permission for a doctor and/or nurse to take remedial action in case of an emergency.  I attest and verify that I have full knowledge of the risks involved in a race, and that I assume all expenses in the event of an accident, illness or other incapacity, regardless of whether I have authorized such expenses.

Signature (Parent or Guardian if participant is under the age of 18).

Date:

Event

Marathon Early Start [   ] (5 HR+)

[  ] Marathon         

[  ] Half Marathon

[  ] Run or
[  ] Walk 

Birthdate

Age on June 5, 2005

Sex:
M or F

Gorge Marathons Completed

For Marathoners, Predicted Time:

:

:

Optional Divisions: Clydesdale [ ]  Athena [ ]
* Clydesdale=200lbs + Athena=150lbs+

FEES:

By

Marathon

Half

03/01

$50

$25

03/29

$60

$27

04/15

$65

$30

05/05

$70

$32

06/03

$85

$35

Day of Race

$100

$40

** Marathon  T-Shirt Included
** Half Marathon T-Shirt $15    

Shirt Size:  M   L   XL  (Circle ONE)

TOTAL ENCLOSED:

 Check [ ] Money Order [ ]

RETURN TO:
GORGE MARATHON
PO BOX 1487
Lake Oswego, OR  97035