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.
MALE______ FEMALE______ AGE ON RACE DAY__________ D.O.B.______/______/______
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 TRIATHLON: 1.2 MI. SWIM, 56 MI. BIKE, 13.1 MI. RUN
___WE ARE ENTERING AS A TRIATHLON TEAM ( each team member must send in entry, AWRL, and pay USAT fees)
||TEAM OF THREE--$130.00 TEAM OF TWO--$110.00|
||TEAM OFTHREE--$145.00 TEAM OF TWO--$125.00|
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.
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______________
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.
PRINT 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.
RELATIONSHIP TO MINOR___________________________________________________________________