Taylor Shellfish Farms
2006 SAMISH BAY BIVALVE BASH
LOW TIDE MUD RUN
July 29, 2006 • Kids Run 1:15 PM • Adults 2:03 PM

ENTRY FORM
 SCEA

Mail or deliver to: Low Tide Mud Run, c/o Taylor Shellfish Farms, 2182 Chuckanut Dr, Bow WA 98232

PERSONAL INFORMATION Entry form required for each participant.
Please print clearly.
First Name     Last Name  
Address  
City     State     Zip  
Day Phone     Evening Phone  
Email (Required for entry confirmation)  
Age on July 29, 2006        Date of Birth:  Month    Day    Year  
Gender (Circle One):   Male   Female

ENTRY FEES
Kid 8-12 (Limited to first 100 entrants): Enter Amount
If Entry postmarked or delivered by July 24: Free  
Free entry with T-Shirt if postmarked or delivered by July 24: $10  
Day of Race Entry: $10 (if openings available)  
Day of Race Entry with T-Shirt (if available): $20 (if openings)  
Shirt Size (Circle one if purchasing)
Kids:  
 S   M   L
   
Adult 13 and up (Limited to first 200 entrants):  
If Entry postmarked or delivered by July 24: $10  
Entry postmarked or delivered by July 24, with T-Shirt: $20  
After July 24, Day of Race entry: $20 (if openings available)  
After July 24, Day of Race entry with T-Shirt (if available): $30 (if openings)  
Shirt Size (Circle one if purchasing)
Adults:  
 S   M   L   XL   XXL
   
Entry fee includes free $5 Bivalve Bash entry for runner.  

Make checks out to: Samish Bay Bivalve Bash Entry Fees are non-refundable and non-transferable.

Allow 1 hour 15 minutes for offsite parking in Blanchard and shuttle bus to site.
RELEASE AND WAIVER Every participant must read and sign.

In consideration of your acceptance of the race entry I for myself, my heirs, administrators, and assignees, forever indemnifies, waives, releases and discharges any and all rights, claims for damages and causes of suit or action, known or unknown that I may have against Taylor Shellfish Farms, and sponsors, municipalities, and any and all participating directors, employees and agents of such parties for any and all injuries in any manner arising or resulting from my participation in said race. I attest and verify that I have full knowledge of the risk, that I will assume and pay my own medical and emergency expenses in the event of accident, illness, or other incapacity, regardless of whether I have authorized such expenses, and that I am physically fit and sufficiently trained to participate in this race.

     
Signature of Participant (or parent/guardian if under 18) Date