2006 SPRINT TRIATHLON ENTRY FORM

Name (SWIMMER): ____________________________________ RACE DAY Age: ________ TriNW #: ________

Address: ________________________________ City: _____________________

State: __________ Zip: _____________ Phone: (         ) _________________

Email: __________________________________________________________ 

BIRTH DAY (mo/day/yr): _____/_____/________    Gender:  M  or  F          Shirt Size:   Sm   Med   Large   XL

CHO0SE CATEGORY:

            TOTAL: ____________ (make checks payable to LCSC Cross Country)

If TriNW Member, your $5.00 refund will be given at Packet pickup on race morning.  You need to show your membership card in order to receive.

IF TEAM ENTRY (CYCLIST)

Name: _________________________________________ Age: ________

Address: ________________________________ City: __________________

State: _________ Zip: _____________ Phone: (        ) ________________

Gender:  M  or  F          Shirt Size:   Sm   Med   Large   XL  

IF TEAM ENTRY (RUNNER)

Name: _________________________________________ Age: ________

Address: ________________________________ City: __________________

State: _________ Zip: _____________ Phone: (        ) ________________

Gender:  M  or  F          Shirt Size:   Sm   Med   Large   XL  

Please Read the Following statement and sign below before submitting entry.

I know that competing in a duathlon is a potentially hazardous activity.  I should not enter and compete unless I am medically able and properly trained.  I assume all risks associated with competing in this event, including, but not limited to falls, contact with other participants, the effects of weather, traffic, interactions with non-participants and the conditions of the road all such risks being known and appreciated by me.  Having read this waiver and knowing these facts and in consideration of the acceptance of my entry, I, myself and anyone entitled to act on my behalf, waive and release any and all sponsors and organizers, their officers, agents and assigns, the race director and volunteers from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of the negligence or carelessness on the part of the persons named in this waiver.  I also understand that my entry fee is non-refundable and non-transferable.  A parent must sign if the child is under 18 years of age.  This certifies that the child has permission to participate and agrees to the previously stated waiver.

Signature: _____________________________________________________ Date: _________________ (SWIMMER)

Signature: _____________________________________________________ Date: _________________ (CYCLIST)

Signature: _____________________________________________________ Date: _________________ (RUNNER)

Signature: _____________________________________________________ Date: _________________ (Parent/Guardian if under 18)

Send entry to:  LCSC Cross Country C/O Dr. Mike Collins, 500 8th AVE, Lewiston, ID  83501