Square Lake Triathlon
REGISTRATION FORM

Saturday and Sunday, September 11 and 12, 2010 


Short Course Saturday___________________      Long Course Sunday_________________________

Age Group__________  Elite________ Team___________ Clydesdale__________ Athena___________
(Athena - women 160+ lbs | clydesdale- men 200+ pounds | Age group -most choose this option) 

Last Name                       First Name                                Age on    Sex  

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                                                                          Race Day    M/F
Mailing address (include apt. # and c/o)                    

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City and State                                                       Zip/Postal Code

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Birth date      Area Code       Telephone                          

|___|___|___|  |__|__|__| |__|__|__|-|__|__|__|__|   
 Mo  Day Yr   

Team Partners(if team)__|__|__|__|__|__|__|__|__|__|__|__|__|__|

Team Partners(if team)__|__|__|__|__|__|__|__|__|__|__|__|__|__|

E-Mail Address 

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T-Shirt Size
|__| Small |__| Medium |__| Large |__| X-Large

WAIVER. I am properly trained and enter this race totally at my own risk and hereby waive all claims that I or my heirs may have against all sponsors, race directors and all others associated with this race, for any injuries or problems I may sustain, regardless of any negligence. I am totally responsible for my safety and any injury I may suffer.. Further, I hereby grant full permission to any and all of the foregoing to use my name, likeness and voice, as well as any photographs, videotape, motion pictures, recordings and any other record of this event in which I may appear for any legitimate purpose including broadcast of the event, the reuse in any media of this broadcast and in advertising and promotion.

Signature
(by parent or guardian if
participant is under 18) ___________________________________________________

MAIL ENTRY FORM WITH ENTRY FEE TO

Make check payable to Vacation Sports

MORE INFORMATION