Entry Form
Memorial Day Triathlon/Duathlon & Footraces & Kids race - May 25, 2009
Mail completed entry form and fee to:
Memorial Day 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 1) $25.00 $ ______
10K (Before May 15) $27.00 $ ______
10K (Before May 25) $30.00 $ ______
10K Day of race $35.00 $ ______
5K (3.1 miles) (Before May 1) $18.00 $ ______
5k (Before May 15) $20.00 $ ______
5k (Before May 25) $23.00 $ ______
5k Day of race $25.00 $ ______
1 mile (Before May 25) $15.00 $ ______
1 mile Day of race $17.00 $ ______
Triathlon Before (May 1) $45.00 $ ______
Triathlon (Before May 15) $47.00 $ ______
Triathlon (Before May 25) $50.00 $ ______
Triathlon Day of race $55.00 $ ______
TRI 2/3 person team (Before May 1) $60.00 $ ______
TRI 2/3 person team (Before May 25) $65.00 $ ______
TRI 2/3 person team day of race $75.00 $ ______
Duathlon (Before May 1) $30.00 $ ______
Duathlon (Before May 15) $35.00 $ ______
Duathlon (Before May 25) $40.00 $ ______
Duathlon Day of race $45.00 $ ______
DU 2/3 person team (Before May 25) $50.00 $ ______
DU 2/3 person team Day of race $55.00 $ ______
Kids race (Before May 25) $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)
