XTERRA DINO Triathlon Entry Form 2008

ALL ATHLETES MUST SIGN A LIABILITY RELEASE AT THE RACE VENUE.

Mail entry with check payable to: DINO LLC, PO Box 36395, Indianapolis IN 46236

Entry Fees -USA Triathlon members may subtract $10

Early Registration - due one week before the event. … SOLO: $60 … RELAY (per team): $120

Day-of-race Registration - availability subject to field limits … SOLO: $70 … RELAY (per team): $130

WHICH TRIATHLON? New Castle July 26____ Logansport Aug 16____ both____

Canoe Rental $20 ___ Total Paid: _______

DIVISION: Triathlon___ Canoe/Kayak___

SOLO___ or RELAY TEAM: All Male___ All Female___ Mixed___ Masters___

Relay members must send entry forms together and use same Team Name at the bottom of this form.

DATE OF BIRTH: |__|__/__|__/__|__| “XTERRA AGE” on Dec 31 2008: _____ SEX: M__ F__

LAST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

FIRST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

STREET ADDRESS: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

CITY: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| STATE: |__|__|

ZIP: |__|__|__|__|__| PHONE#: (____)|__|__|__-__|__|__|__|

E-MAIL: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

T-SHIRT SIZE: S___ M___ L___ XL___

USA TRI # (if applicable): |__|__|__|__|__|__| XTERRA ID # (if applicable): |__|__|__|__|__|__|

SWIM WAVE PREFERENCE (see SWIM WAVES section): Competitor____ Survivor____

PHYSICALLY CHALLENGED DIVISION? No___ Yes___

EMERGENCY CONTACT INFO:

NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

PHONE#: (____)|__|__|__-__|__|__|__| or SPECTATOR AT THE EVENT ___

TEAM/SPONSOR: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

OCCUPATION: _______________ TIDBIT ABOUT YOURSELF: ________________________