USA Triathlon Sanctioned Event
Please include $10 + $2 handling fee, One-Day Membership
or USAT #_________________
Circle One: Individual: Before March 30, $35; March
31-April 6, $45; April 7-April 20, $55; Race Day, $70.
Relays:Before March 30, $15/person; March 31-April
6, $20/person; April 7-April 20, $25/person; Race Day, $30/person.
(Relay teams may include two or three person teams.)
Under the age of 18: $20.
NAME ___________________________________________________
STREET ADDRESS________________________________________
CITY________________________________STATE___________ ZIP____________
HOME PHONE______________________ DAYTIME/WORK PHONE_____________________
E-MAIL ADDRESS_______________________________________
BIRTHDATE________________________AGE ON RACEDAY_________
GENDER - circle one MALE FEMALE
T-shirt size - circle one S M L XL
EMERGENCY CONTACT_________________________________________
The Louisiana Triathlon in Pointe Coupée Parish
Race Waiver for All Participants
I know that participating in a triathlon like the Louisiana
Triathlon is a potentially hazardous activity. I should not enter or participate
in the Louisiana Triathlon unless I am medically able and properly trained.
I agree to abide by any decision of race officials relative to my ability
to safely compete in the Louisiana Triathlon. I assume all risks associated
with participating in the Louisiana Triathlon, including , but not limited
to, falls; contact with other participants; the effects of weather, including
high heat and/or humidity; traffic and the conditions of the road or paths
used in the contest, all such risks being known by and appreciated by me.
Having read this waiver and knowing these facts, and in consideration of
your acceptance of my entry, I, for myself, and anyone entitled to act
on my behalf, waive and release the city of New Roads, Pointe Coupée
Parish, the race directors, and all representatives and successors from
claims or liabilities of any kind arising out of my participation in the
Louisiana Triathlon. I grant permission to all the foregoing to use any
photograph, motion pictures, video tapes, recording or any other record
of the Louisiana Triathlon for any legitimate purpose.
Signature _____________________________________________ Date______________
Signature of parent or guardian if entrant is under the
age of 18 ___________________________________________