DINO Triathlon Entry Form 2006

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 $9

Early Registration - must be received one week before the event. … SOLO: $55 … RELAY (per team): $120

Day-of-race Registration - availability subject to field limits … SOLO: $65 … RELAY (per team): $130

WHICH TRIATHLON? Logansport July 29____ New Castle Aug 19____ both____

Kayak 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 2006: _____ SEX: M__ F__

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

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

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

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

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

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

T-SHIRT SIZE: S___ M___ L___ XL___

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

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

EMERGENCY CONTACT INFO:

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

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

OPTIONAL:

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

OCCUPATION: _______________ TIDBIT ABOUT YOURSELF: _____________________________