1999 USA Winter Cross Country National Championships

Individual Entry Form, USA Cross Country Championships, 13-14 February 1999

Deadline

February 6, 1999 (received) -- Early Entry Fee = $20.00
February 7-12, 1999 (received) -- Late Entry Fee = $40.00

Please make check payable and send to: (NO REFUNDS)

Pacific Northwest Track & Field
Attn: USA Cross Country Championships
4261 S. 184th Street
SeaTac, WA 98188-4569

This form is to be completed by all runners, including each member of a team (photocopy additional forms as needed). Please print all information clearly.

Last Name _________________________ First Name _________________

USATF Number |___|___|___|___|___|___|___|___|___|___|

Affiliation ________________________________________

Address _________________________________________ Sex: ___ Male ___ Female

City ____________________________________________

State ______ Zip |___|___|___|___|___|

Phone ( ___) ____________ Best recent 10k time __________ Date of birth ___ ___ ___ Age on race day ______

Race:
___ Junior Men 8k ___ Junior Women 6k ___ Senior Men 4k ___ Senior Women 4k

___ Senior Men 12k ___ Senior Women 8k ___ Masters Men 6k ___ Masters Women 4k

T-shirt size: ___ Med ___ Large ___ X-Large

Waiver (please read and sign): I know that running, regardless of the distance, includes an element of risk. I should not enter and participate in the 1999 USA Winter Cross Country National Championships (herein after called this event) unless I am medically able and properly trained. I agree to abide by any decision of an event official relative to my ability to compete in this event safely and I further agree that the event officials may authorize necessary emergeny treatment for me. I also understand any and all risks associated with this event including, but not limited to, illness, traveling to and from this event, falls, contact with spectators and other participants, the effects of weather (including temperature and humidity extremes) and the surface of the event's course, all such risks being understood by me.

Having read this waiver and knowing the facts, and in consideration of my entry, I hereby for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue, and waive, release, and discharge USA Track & Field, Pacific Northwest Track & Field, Lake Spanaway Golf Course, Pierce County Parks and Recreation, event officials, volunteers, and any and all sponsors, suppliers, agents, independent contractors, employees and any other personnel in any way assisting or connected with this event, even though the liability may arise out of negligence or carelessness on the part of persons or parties in this waiver.

I also understand and agree that any sponsor may subsequently use, for publicity purposes, my name and pictures of me participating in this event without liability or obligation due me. I also understand that as a result of my participation in this event that I may be drug tested by USATF and, if found positive, may be disqualified from this event and suffer other consequences in accordance with USATF and IAAF rules.

Signature _________________________________ Date _____________
(must be signed by parent or guardian if under 18)