2009 TRI-STATE OUTFITTERS Duathlon ENTRY FORM
Send Payment to
Mike Collins, LCSC Cross Country, 500 8th AVE, Lewiston, ID
83501 (Make checks out to LCSC XC)
[ ] Individual with Shirt - - - - - - - - $35.00 .
[ ] Individual without Shirt - - - - - - - - - -$25.00
[ ] 2-Person Team with Shirts - - - -- - $40.00 .
[ ] 2-Person Team without Shirts- - - - - -$35.00
[ ] Late Fee per Person - - - - - - - - - - - - - - - - - - - $5.00 (AFTER
March 14)
If TriNW Member, your $5.00 refund will be given at Packet pickup on race
morning with card.
INDIVIDUAL OR TEAM ENTRY (RUNNER)
Name: ____________________________________ Address: ___________________________
City: ___________________ State: _______ Zip: __________ Phone: ( )
_____________
Age: _____ Email: _______________________________________________
Birthday: ______ / ______ / ______ TriNW #: _________ Gender: M or F
Shirt Size: Sm Med Large XL
IF TEAM ENTRY (CYCLIST)
Name: ____________________________________ Address: ___________________________
City: ___________________ State: _______ Zip: __________ Phone: ( )
_____________
Age: _____ Email: _______________________________________________
Birthday: ______ / ______ / ______ TriNW #: _________ 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.
ACTS OF GOD & OTHERS DISCLAIMER:
Although it is not anticipated that weather, road construction, etc.. will
affect the race. The
race organizers reserve the right to adjust the course, the time of the race and
anything
other compensations necessary due to factors beyond their control which
includes, but
is not limited to weather, road construction, ... In eleven years of putting on
these races
we have never had to worry about this type of an event, but want to be sure that
any and all
participants are aware that it could happen and that we will make every effort
to conduct
the race to the best of our ability with the safety of all participants and
volunteers in mind.
Signature: _____________________________________ Date: _________________
Signature: _____________________________________ Date: _________________
Signature: _____________________________________ Date: _________________
(PARENT if entrant is under age of 18)