Sunday, July 12, 2009 -- Richwood, WV / Summit Lake - Monongahela National Forest
24th Annual Scenic Mountain Triathlon ENTRY FORM
Please Mail and Make Checks Payable to:
RICHWOOD AREA CHAMBER OF COMMERCE, P.O. Box 267, Richwood, WV 26261
For Additional Information Call: (304) 846-6790 or rwdchamber@richwoodwv.com
REGISTRATION FORM
(Please print application and mail to address below. Pre-Registration is due by June 27, 2009. When registering as a USA Tri-Member, you must have a valid Membership Card. For USA Triathlon membership applications call (719)597-9090. Registration fees are refundable up to the day of the event and nontransferable. If you have trouble printing from your internet browser, press "Ctrl A" to select all information on page; then press "Ctrl C" to copy all information from page; then open a blank page in Word or similar program; then press "Ctrl V" to paste information in Word or similar program; then press "Ctrl P" to print.)Individual
TEAM: (circle one) Male Female Mixed Sex Age Shirt SizeNAME (individual or captain) __________________________________________
PHONE:______________________ E-MAIL:_____________________________
ADDRESS: ________________________________________________________
CITY: ______________________________ USAT # (if applicable)____________
STATE: _______________________________ ZIP CODE:__________________
If individual, supply Sex (Male or Female), Age_____, Shirt Size (S, M, L, XL)
TEAM NAME:______________________________________________________
List Member?s Names
Swim:___________________________, Sex (M or F), Age_____, DOB__________, Shirt Size (S, M, L, XL)
Bike:____________________________, Sex (M or F), Age_____,DOB__________, Shirt Size (S, M, L, XL)
Run:____________________________, Sex (M or F), Age_____,DOB__________, Shirt Size (S, M, L, XL)
REGISTRATION FEES ENCLOSED:
- Pre-Registered # of Persons on Team ( )
- $150.00 entry fee per team $________
- Day of Race # of Persons on Team ( )
- $165.00 entry fee per team $________
- Pre-Reg. Individual USA Tri. Member Fee $60 $_____
- Pre-Reg. Individual Non-member Fee $70 $_____
- Day of Race Individual Member Fee $70 $_____
- Day of Race Individual Non-member Fee $80 $_____
- Note: Registration Fee includes T-Shirt, pasta dinner and cookout following race.
- Pre Race Pasta Dinner # of Guest Tickets ( )
- 6:00-8:00pm, Saturday - July 11th, 2009 -Knights of Columbus Hall
- Competitors and age 5 and under free/age 6 and over $6 each $_____
- REGISTRATION AND DINNER TOTAL $________
Along with this entry form:
Please, review, print, sign and mail USATriatilon Waiver Form and visit USA Triathlon's web site!