INSTRUCTIONS: YOU MAY PRINT THIS ENTRY FORM AND SEND TO THE ADDRESS ABOVE OR YOU MAY OPEN THIS PAGE IN WORD AND THEN E-MAIL THE COMPLETED FORM TO SPORTS CONNECTION. PLEASE BE SURE TO INCLUDE YOUR PAYMENT AS WE WILL NOT ENTER YOU INTO THE RACE UNTILL PAYMENT IS RECEIVED. I HOPE TO HAVE THIS FORM SO THAT YOU CAN FILL IT OUT AND E-MAIL BACK TO US IN THE NEAR FUTURE.
NAME(first)______________________________(last)___________________________________________
MALE______ FEMALE______ AGE ON RACE DAY__________ D.O.B.______/______/______
ADDRESS______________________________________________________________________________
CITY______________________________________________________STATE______ZIP______________
PHONE: (_________)____________________E-MAIL___________________________________________
FAX:(___________)_____________________T-SHIRT SIZE: M_____ L_____ XL_____
____YES, I AM A MEMBER OF U.S.A. TRIATHLON. MY NUMBER IS:_______________________________
____NO, I AM NOT A MEMBER OF USA TRIATHLON.
DO NOT SEND USAT FEES WITH THIS ENTRY. USAT FEES ARE $9
(ONE DAY MEMBERSHIP) OR $30 (ANNUAL MEMBERSHIP). YOU WILL PAY
USAT FEES AT PACKET PICK-UP......
___I AM ENTERING THE DUATHLON: 56 MI. BIKE (TIME TRIAL START), 13.1 MI. RUN
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VOLUNTEERS: We always need volunteers to help with the event. If a family member or friend is attending Desert Sun 2002 with and would like to get in on the action as a volunteer we would love to have them help. They will receive a staff t-shirt and a free post race meal. Please list their name(s) and phone number(s) and we will contact them. Thank you for your help in advance.
NAME:________________________________________________________________________________PHONE:___________________________
NAME:________________________________________________________________________________PHONE:___________________________
POST RACE MEAL TICKETS @ $13.00 EACH----NUMBER OF TICKETS_______@$13=________________
PLUS ENTRY FEE $ ________________
TOTAL ENCLOSED $ ________________
CHECK FOR $_____________________ENCLOSED OR CREDIT CARD INFOMATION: ___VISA ___MC ___AMEX ___DISCOVER
CREDIT CARD #___________________________________________________EXPIRES______________
PRINTEDNAME:_________________________________________________________________________
SIGNATURE_______________________________________________________DATE_________________
PLEASE READ CAREFULLY BEFORE SIGNING THIS
ACKNOWLEDGEMENT, WAIVER AND RELEASE FROM LIABILITY(AWRL)
I acknowledge that a triathlon, duathlon, or multi-sport event
is an extreme test of a person's physical and mental limits and
carries with it the potential for death, serious injury, and property
loss. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN TRIATHLONS,
DUATHLONS, OR MULTI- SPORT EVENTS. I certify that I am physically
fit, have sufficiently trained for participation in this event(s),
and have not been advised against participation by a qualified
health professional. I acknowledge that my statements on this
AWRL are being accepted by USA Triathlon ("USAT") in
consideration for allowing me to become a member of USAT and are
being relied upon by USAT and the various race sponsors, organizers
and administrators in permitting me to participate in any USAT
sanctioned event.
In consideration for allowing me to become a member in USAT and
allowing me to participate in USAT sanctioned events, I hereby
take the following action for myself, my executors, administrators,
heirs next of kin, successors and assigns, or anyone else who
might claim or sue on my behalf, and I expressly acknowledge that
it is my intent to take these actions: (a) I AGREE to abide by
the Competitive Rules adopted by USAT, including the Doping Control
Rules, as they may be amended from time to time, and I acknowledge
that my membership may be revoked or suspended for violation of
the Competitive Rules; (b) I AGREE that prior to participating
in an event I will inspect the race course, facilities, equipment,
and areas to be used and if I believe any are unsafe I will immediately
advise the person supervising the event; (c) I WAIVE, RELEASE,
AND FOREVER DISCHARGE from any and all claims, losses (economic
and non-economic), or liabilities, for death, personal injury,
partial or permanent disability, property damage, medical or hospital
bills, theft, or damages of any kind, which may in the future
arise out of, result from, or relate to my participation in or
my traveling to or from a USAT sanctioned event, THE FOLLOWING
PERSONS OR ENTITIES: USAT, EVENT SPONSORS, RACE DIRECTORS, EVENT
PRODUCERS, VOLUNTEERS, ALL STATES, CITIES, COUNTRIES, OR OTHER
GOVERNMENTAL BODIES OR LOCATIONS IN WHICH EVENTS OR SEGMENTS OF
EVENTS ARE HELD, AND THE OFFICERS, DIRECTORS, EMPLOYEES, REPRESENTATIVES
AND AGENTS OF ANY OF THE ABOVE, EVEN IF SUCH CLAIMS, LOSSES, OR
LIABILITIES ARE CAUSED BY THE NEGLIENT ACTS OR OMISSIONS OF THE
PERSONS I AM HEREBY RELEASING OR ARE CAUSED BY THE NEGLIGENT ACTS
OR OMISSIONS OF ANY OTHER PERSON OR ENTITY; (d) I ACKNOWLEDGE
that there may be traffic or persons on the course route, and
I ASSUME THE RISK OF RUNNING, BIKING, SWIMMING OR PARTICIPATING
IN ANY OTHER EVENT SANCTIONED BY USAT under these circumstances.
I also ASSUME ANY AND ALL OTHER RISKS associated with participating
in USAT sanctioned events including but not limited to falls,
contact and/or effects with other participants, effects of weather
including heat, cold, and/or humidity, defective equipment, the
condition of the roads, water hazards, contact with other swimmers
or boats, and any hazard that may be posed by spectators or volunteers,
all such risks being known and appreciated by me; and I further
acknowledge that these risks include risks that may be the result
of the negligence of persons or entities mentioned above in subparagraph
(c) or of other persons or entities. I FURTHER COVENANT AND AGREE
NOT TO SUE any of the persons or entities mentioned above in subparagraph
(c) for any of the claims, losses, or liabilities that I have
waived, released, or discharged herein; and I INDEMNIFY AND HOLD
HARMLESS the persons or entities mentioned above in subparagraph
(c) from any and all expenses incurred, claims made, or liabilities
assessed against them, including but not limited to attorneys'
fees and litigation expenses, arising out of or resulting from,
directly or indirectly, in whole or in part, (i) my actions or
inactions, (ii) my breach or failure to abide by any part of this
AWRL including but not limited to my covenant not to sue; (iii)
my breach or failure to abide by any of the Competitive Rules;
or (iv) any other harm caused by me. I FURTHER GRANT PERMISSION
for the use of my name and/or likeness relating to my participation
in a USAT sanctioned event, and I WAIVE all rights to any future
compensation to which I may otherwise be entitled as a result
of the use of my name or likeness.
I HEREBY AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER,
I HAVE READ THIS DOCUMENT, AND I UNDERSTAND ITS CONTENT.
PRINTED NAME ______________________________________________________SIGNATURE________________________________________________________________________
DATE___________________
For persons under 18 years of age, a parent or legal guardian
must sign the above AWRL and complete the following section.
The undersigned __________________ (parent/guardian) the parent
and natural guardian of ___________________ (minor's name) hereby
acknowledges that he/she has executed the foregoing AWRL for and
on behalf of the minor named herein. As the natural or legal guardian
of such minor, I hereby bind myself, the minor, and our executors
administration, heirs, next of kin, successors, and assigns to
the terms of the foregoing AWRL. I represent that I have the legal
capacity and authority to act for and on behalf of the minor named
herein, and I agree to indemnify and hold harmless the persons
or entities mentioned in the foregoing AWRL for any expenses incurred,
claims made, or liabilities assessed against them, as a result
of any insufficiency of my legal capacity or authority to act
for and on behalf of the minor in the execution of the foregoing
AWRL or in the execution of this consent and authorization for
medical treatment.
I hereby authorize any licensed physician, emergency medical technician,
hospital or other medical or health care facility ('Medical Provider')
to treat the minor named herein for the purpose of attempting
to treat or relieve any injuries received by said minor arising
out of or relating to any event sanctioned by USAT. I authorize
any such Medical Provider to perform all procedures deemed medically
advisable by the Medical Provider in attempting to treat or relieve
any such injuries and any related conditions of said minor that
may be encountered during the course of attempting to treat or
relieve such injuries. I consent to the administration of anesthesia
as deemed advisable during the course of such treatment. I realize
and appreciate that there is a possibility of complications and
unforeseen consequences in any medical treatment, and I assume
any such risk for and on behalf of said minor and myself. I acknowledge
that no warranty is being made as to the results of any medical
treatment.
NOTE: Parent/Guardian must also sign AWRL above.
PARENT/GUARDIAN SIGNATURE___________________________________________________________DATE___________
RELATIONSHIP TO MINOR___________________________________________________________________