Entry Form.

 

Entry Form for the 2010 Louisiana Triathlon in Pointe Coupée Parish


Print out entry form, neatly fill and send it with your entry fee to:


Kenny Dunaway, C/o Louisiana Triathlon, 1708 Hood Avenue, Baton Rouge, LA  70808


You may also enter online at  WWW.ACTIVE.COM



Application for 2009 Louisiana Triathlon in Pointe Coupée Parish

Saturday, April 18, 2009

Race starts at 8:00 a.m.


USA Triathlon Sanctioned Event

Please include $12 + $2 handling fee for One-Day Membership or USAT # _______


Circle one:

Individual:  Before Feb. 1, $35; Feb. 2 – March 10, $45; March 11 – April 18, $55; Race Day - $70; Under age 18, $20.

Relays:  Before Feb. 1, $15/person; Feb. 2 – March 10, $20/person; March 11 – April 18, $25/person; Race Day, $30/person. 

oRelay teams may include two or three person teams.

Return Check Fees = $25.


NAME: ______________________________________________________________________________________


STREET ADDRESS: ___________________________________________________________________________


CITY: ___________________________________ STATE: _______________ ZIP: _________________________


HOME PHONE: ___________________________ DAYTIME/WORK PHONE: ___________________________


E-MAIL: _____________________________________________________________________________________


BIRTH DATE: ___________________________________ AGE ON RACE DAY: _________________________


GENDER: circle one – MALE      FEMALE


T-SHIRT SIZE: circle one – S    M    L    XL


EMERGENCY CONTACT: ______________________________________________________________________



Pre-registered participants will also be required to sign a second on-site race waiver from USA Triathlon to verify signatures and show a photo ID and USAT membership card.  Sorry, NO REFUNDS! Race goes on rain or shine!


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, Pointed 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, videotapes, 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:


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