PACKET PICKUP: Thursday, Feb 4th at Trinidad Town Hall (5pm-7pm)
Friday, Feb 5th at Red Lion Hotel - 1929 4th St., Eureka (4pm - 6pm)
Race Morning, Sat, Feb 6th at Trinidad Town Hall (7:30am - 9:30am)

Mail to:
Trinidad Chamber of Commerce
PO Box 356
Trinidad, CA 95570

Event (Choose One) - (entry fee includes T-shirt) - FAMILY RATE: Deduct $4.00 from each entry for Family rate (applies only to the participants with multiple family members competing, and if postmarked by December 31, 2009).

- 8-3/4 Mile Run/Walk (on or before December 31, 2009) - $18.00 8-3/4 Mile Run/Walk (Jan 1 - Feb. 3 2010) - $22.00 8-3/4 Mile Run/Walk (Thurs/Fri/Sat Feb. 4-6, 2010) - $28.00 5-3/4 Mile Run/Walk (on or before December 31, 2009) - $18.00 5-3/4 Mile Run/Walk (Jan 1 - Feb. 3, 2010) - $22.00 5-3/4 Mile Run/Walk (Thurs/Fri/Sat Feb. 4-6, 2010) - $28.00 3-Mile Run/Walk (on or before December 31, 2009) - $18.00 3-Mile Run/Walk (Jan 1 - Feb. 3, 2010) - $22.00 3-Mile Run/Walk (Thurs/Fri/Sat Feb. 4-6, 2010) - $28.00

First Name / MI / Last Name

ChampionChip Number (if applicable - Example - CE12345)

Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy

Age

Gender
- Female Male
Phone

Email

Division (Individual)
- 10 years & under 11 - 14 years 15 - 18 years 19 - 24 years 25 - 29 years 30 - 34 years 35 - 39 years 40 - 44 years 45 - 49 years 50 - 54 years 55 - 59 years 60 - 64 years 65 - 69 years 70 - 74 years 75 - 79 years 80 years & over
T-Shirt Size (included with race entry fee)
- Small Medium Large X-Large
Check#

Amount Enclosed


WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
WAIVER & RELEASE: READ THIS! I know that running/walking a road race is a potentially hazardous activity. I should not enter and run/walk unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I assume all risks associated with participating in this event including, but not limited to falls, contact with other participants, the effects of weather, including high 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 acceptance of my entry, I for myself and anyone entitled to act on my behalf, waive and release any and all persons, sponsors and entities, their representatives and successors from all claims or liabilities of any kind arising out of my participation even though said liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission for all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. Parents must sign if participant is under 18 years of age. This is to certify that my child has permission to complete in this event, is in good physical condition and that event officials may authorize necessary emergency treatment. I agree to return the Timing Chip assigned to me or pay a $30.00 replacement fee. ENTRY FEES ARE NON-REFUNDABLE.

Type Full Name


Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)

Date________________________________________