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Tupper Lake Tinman Triathlon - Entry
Application Please Print an Application for each team member to fill out Deadline June 5th (This race is subject to close if our max number of racers is received)
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Tupper Lake Tinman Triathlon - Entry
Application Please Print an Application for each team member to fill out Deadline June 5th (This race is subject to close if our max number of racers is received)
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$10 One Day Fee ________ USAT # _________________________ (A USAT Card & Photo ID only must be shown at Registration or $10 one day fee will apply. LAST NAME: __________________________________ FIRST NAME: ________________________ MAILING ADDRESS: ________________________________________________________________ CITY:_________________________________________STATE: ____________ ZIP:______________ DAY PHONE: _______________________________ EMAIL: ________________________________ DOB: _____________________ M OR F ____________________Age End of Dec 2009: ___________ T-SHIRT (S-M-L-XL)________________________________________________________________ Race Day Emergency Information: Name: ___________________ Phone: _________________________ Medical Problems (circle) Y OR N EXPLAIN:_____________________________________________ RACE STATUS (circle one) TINMAN //// SPRINT /// /TEAM/// Team Name Only if registering for a Team: _____________________________________________
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All Entry Fees include: T-Shirt, Carbo-Dinner, Post Race Dinner, Swim Cap and information in your race packets. Packet Pick-up & Registration is 10 am to 8:30 pm. Carbo-Dinner will begin at 4 pm and end at 8:00 p.m. No one is allowed to pick packets up for anyone other then yourself. NO ID NO RACE. All Entry Fees are Non Refundable & Non Transferable All Checks/Money Orders MUST be in U.S. FUNDS or your check will not be accecpted. A $75 fee is attached to all Returned Checks. Other Fees up to an additional amount of $50 can apply for Canadian Checks. To avoid these fee’s use a credit card at www.active.com
Make Checks Payable to Tupper Lake Tinman Mail to Race Director: Michele Cote Tinman Triathlon 92 Ivy Terrace, Tupper Lake, NY 12986
Please consider a Donation: as a non profit race we strive to make improvements and replacements for our race as well as offer Scholarships that are given to our local seniors, community Sponsorships and children’s events. If you would like to make a donation for one or any of the above we thank you and ask you to please add it to the total fees.
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Race Type |
Entry Fee |
Late Fee (April 1st 2009) |
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Tinman |
$135.00 |
$155.00 |
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Sprint |
$115.00 |
$135.00 |
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Team |
$ 200.00 |
$225.00 |
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Totals:
Donation Amount: |
_________ |
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Entry Fee: |
_________ |
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$10 One Day : |
_________ |
Or USAT # ____________ |
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Total Sent: |
_________ |
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Please read: In consideration of you accepting this entry. I, the undersigned do hereby waive and release the Tupper Lake Chamber of Commerce, sponsors, officials and municipalities through which the race is run, from all liabilities and claims arising from my participation in this race. I grant permission to use photo’s videos, or any other records of this race from any legitimate purpose. I have read or heard the rules to this race. I attest that I am physically fit and have sufficiently trained for this race. The Tupper Lake Tinman Triathlon is owned and operated by the Chamber of Commerce of Tupper Lake, NY. A copy of the latest annual report may be obtained, upon request, from the Chamber of Commerce of Tupper Lake or from the New York State Attorney General’s Charities Bureau, attn: FOIL Officer, 120 Broadway, New York, NY 10271.
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Participant Signature:________________________ |
Date:______________ |
