Entry Form
Firecracker Triathlon/Duathlon & Footraces & Kids race - July 4, 2009
Mail completed entry form and fee to: Firecracker Triathlon/Duathlon & Footraces & Kids race, @ 9435 180th Way Sw, Rochester, Wa 98579, Elma, WA
(Please print)

Name (first)                           (last)
|__|__|__|__|__|__|__|__|__|__|__|__|  |__|__|__|__|__|__|__|__|__|__|__|__|
Address
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
City                                   State         Zip
|__|__|__|__|__|__|__|__|__|__|__|__| |__|__| |__|__|__|__|__|
Phone                                      Sex        Age on Race Day
|__|__|__| |__|__|__| |__|__|__|__|       M    F         |__|__|

FEES: (Entries include T-shirt):

10K (6.2 miles) (Before May 23)      $25.00  $ ______
10K             (Before June 15)     $27.00  $ ______
10K             (Before July 4)      $30.00  $ ______
10K           Day of race            $35.00  $ ______
5K (3.1 miles)   (Before May 23)     $18.00  $ ______
5k               (Before June 15)    $20.00  $ ______
5k               (Before July 4)     $23.00  $ ______
5k            Day of race            $25.00  $ ______
1 mile        (Before July 4)        $15.00  $ ______
1 mile        Day of race            $17.00  $ ______
Triathlon     Before (May 23)        $45.00  $ ______
Triathlon     (Before June 15)       $47.00  $ ______
Triathlon     (Before July 4)        $50.00  $ ______
Triathlon     Day of race            $55.00  $ ______
TRI 2/3 person team (Before June 15) $60.00  $ ______
TRI 2/3 person team (Before July 4)  $65.00  $ ______
TRI 2/3 person team day of race      $75.00  $ ______
Duathlon      (Before May 23)        $30.00  $ ______
Duathlon      (Before June 15)       $35.00  $ ______
Duathlon      (Before July 4)        $40.00  $ ______
Duathlon      Day of race            $45.00  $ ______
DU 2/3 person team (Before July 4)   $50.00  $ ______
DU 2/3 person team  Day of race      $55.00  $ ______
Kids race (Before July 4)            $18.00  $ ______
Kids race      Day of race           $20.00  $ ______
           No shirt option           -$5.00  $ ______
           Extra short sleeve shirt   $8.00  $ ______
           Extra tank top            $12.00  $ ______
           Extra longsleeve          $15.00  $ ______
           Extra sweatshirt          $20.00  $ ______
           Upgrade to tank top       $10.00  $ ______
           Upgrade to longsleeve     $11.00  $ ______
           Upgrade to sweatshirt     $18.00  $ ______

TOTAL ENCLOSED                               $ ______
T-shirt Size (circle one): 
Adult S  M  L  XL   XXL
Child S  M  L  XL

MAKE CHECK PAYABLE TO: Kristina Salazar, 9435 180th Way, Sw, Rochester, WA 98579

Waiver I HEREBY RELEASE THE PUGET SOUND CRUISER, THE CITY OF ELMA, STATE OF WASHINGTON, COUNTY OF GRAYS HABOR, VANCE CREEK PARK, EMPLOYEES, VOLUNTEERS OR ANYONE ELSE INVOLVED IN THE ABOVE EVENTS. I HAVE TRAINED FOR THIS EVENT AND KNOW MY ENTRY IS NON-REFUNDABLE NO MATTER W HAT THE REASON AND I WILL NOT ASK FOR IT BACK. I HAVE NO MEDICAL CONDITIONS AND KNOW THE COURSE IS NOT CLOSED TO TRAFFIC. THE DECISION OF THE RACE DIRECTOR IS FINAL AND I WILL OBEY ALL RULES OF THE ROAD. I ALSO KNOW BY SIGNING THIS FORM, I'M WAIVING MY RIGHT TO SUE FOR ANY AND ALL REASONS, INCLUD ING BUT NOT LIMITED TO PERSONAL INJURY OR DEATH.

__________________________________________________________________
Signature of Athlete Date (Signature of Parent or Guardian if under 18 years)

For more information call 360-273-9684 or wanttoduit@hotmail.com

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