entry form

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TEAM ENTRY

PLEASE NOTE: Teams are made up of three people. Standard prices: 7th - 24th February

Team Entry:

Team

$8.00 FREE

10 –12 years Team TEAM NAME: COMPANY/SCHOOL: TOWN/CITY:

PHONE:

Emergency Contact Name:

Phone:

TEAM CAPTAIN

TEAM MEMBER #1 First Name: Gender:

F

Date of Birth:

Last Name:

M

Email:

DD / MM / YYYY

All event information will be emailed out prior to the event

Age:

School Year:

Phone:

TEAM MEMBER #2 First Name: Gender:

F

Date of Birth:

Last Name:

M

Email:

DD / MM / YYYY

All event information will be emailed out prior to the event

Age:

School Year:

Phone:

ENTRY FORM

TEAM MEMBER #3 First Name: Gender:

F

Date of Birth:

Last Name:

M

Email:

DD / MM / YYYY

All event information will be emailed out prior to the event

Age:

School Year:

Phone:

www.sporty.co.nz/mitre10martontriathlon As the Team Captain, I consent that all team members have read the Event Waiver & Release over page, and agree to

Signed:

Date:

Event Information Final event information including registration and race times will be emailed out to participants the week before the event. On the Tri day Check-in & Bib Collection will be open from 7.30am with the Race Briefing at 8.30am.

INDIVIDUAL ENTRY F

Last Name:

Gender:

Please visit the event website for more information

Date of Birth:

Venue: Rangitikei College, Marton

School/Company:

M

Email:

DD / MM / YYYY

Town/City:

Food & Drink

Emergency Contact Name:

you

would

have

worked

up

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appetite

after

the

triathlon

so

why

All event information will be emailed out prior to the event

Age: School Year:

This year’s Mitre 10 Marton Triathlon will take place at Rangitikei College in Marton

know

If you would like to enter a team, please use the form on the back.

First Name:

Races will start at 9am with the Prize– giving scheduled to take place at 12noon.

We

Please fill in this form if you are completing an individual entry.

Phone: Phone:

not

purchase something to eat. For those who would rather some basic BBQ food - we have that covered too! Rangitikei College will be on-site around the Tri Hub with delicious BBQ food that you can purchase on the day, just make sure you have cash handy!

Please enter me in the individual...

Waiver & Release Please ensure you read the below waiver & release before signing your Registration Form:

In signing this waiver and release I understand the intent thereof, and I hereby agree to release from responsibility and waive all claims against Mitre 10 Marton and Sport Whanganui it’s corporate sponsors, cooperating organisations, and any other parties connected with this event in anyway, or person, singly or collectively, for any blame or liability, injury, harm, loss of property, or damage that I might sustain as a result of participation in the Mitre 10 Marton triathlon event and activities associated therewith. I fully accept and assume all risks and all responsibility for losses, costs and damages I incur as a result of my participation in this event. I certify that I have read this waiver, fully understand that I have given up substantial rights by signing this waiver and have signed this waiver freely of my own will and accord. I confirm that the information provided to be correct. I agree that I will adhere to the rules and regulations set forth by Sport Whanganui for the Mitre 10 Marton Triathlon event which will be held on Sunday 5th March 2017 at Rangitikei College in Marton. I am aware of the nature of the event in which I am entering, and understand a moderate level of fitness is required to make my way around the course. I give full permission for the use of my name and any photographs of myself to be used in connection with this event and understand no refunds will be given should I decide not to participate once completing the registration process.

Please note: 10—12 year old participants can enter the short course only

Course lengths available

McIlwaine Builders 10 –12 year old

FREE

McIlwaine Ready Mix Short Course

$4.00

McIlwaine Timber Medium Course

$4.00

Mitre 10 Marton Long Course

$4.00

By signing this entry form, I acknowledge I have read the Waiver & Release and agree to the terms outlined within.

Signed:

Date:

OFFICE USE ONLY Entry Fee:

$__________ : _____

TOTAL ENTRY

$__________ : _____

PAID BY:

Cash

RECEIPT #: _________________

Cheque

Eftpos