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Official Almost My First Triathlon Entry Form

Sex: M ___ F ___

Date of Birth day ____ / month ____ / year _______ Age _____

Last Name ______________________________________

Please Print Clearly

First Name ____________________________ Initial _____

Address _____________________________Suite _______

City ________________________ Province/State _______

Country _____________ Postal/Zip Code _____________

Phone (eve) ___________________ (day) _________________

Fax __________________ email _______________________

Shirt Size: S M L XL

Event Date: June 25th, 2005

Fee Schedule (postmarked by)

Late	June 16th	$69.00
Very Late	June 20th	$79.00
Almost Too Late	June 21-25th	$89.00

Total Enclosed $ ____________

Those athletes already signed up for My First Triathlon 2005 may subtract $20 from the listed fees.

The fees are to encourage athletes to sign up early so we know how many medallions and shirts to order, to prepare the race venue, and commit you to train.

Make cheque/money order payable to: Canadian Endurance Sport

Athlete Questionaire

How/Where did you hear about Almost My First Triathlon ?_____________________

Occupation ______________________________________

Special Medical Alert _______________________________

Estimated times for this year: (optional)

Swim ________ Bike ________ Run ________

List notable accomplishments (for race programs and announcer information). Continue on additional sheet, if required. Races done, rivers crossed, mountains climbed, families raised, etc.

READ CAREFULLY BEFORE SIGNING

I acknowledge that a triathlon or duathlon 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 OR DUATHLONS. I certify that I am physically fit, have sufficiently trained for participation in this event(s), and have not been advised otherwise by a qualified medical person. I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns as follows: a) WAIVE, RELEASE, DISCHARGE AND AGREE NOT TO SUE from any and all liability for my death, disability, personal injury, property damage, property theft or action of any kind which may hereafter accrue to me as a result of my participation in, or my traveling to and from THE FOLLOWING ENTITIES: My First Triathlon related event 2005, Event Sponsors, Event Directors, Event Producers, Event Workers and Volunteers, Event Connected charities, and all cities, countries, districts, public agencies and /or provinces in which said Events may be staged or in which segments of said Events may be run or have responsibility therefore and the officers, directors, employees, representatives and agents and volunteers of all of the above.

b) INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned in this paragraph from any of my actions during an Event. This waiver release and indemnification agreement is not intended to encompass claims arising out of intentional misconduct by covered parties. I acknowledge that the above Waiver and Release applies specifically to the My First Triathlons (MFT) and to all persons and entities associated with it. I hereby consent to receive medical treatment in the event of my injury, accident and/or illness, during any event. I understand that at (MFT) Events or related activities, I may be photographed, I agree to allowing my photo, video or film likeness to be used for any legitimate purpose by (MFT), the Event producer(s), Event sponsors and/or assigns. I hereby consent that I am nineteen (19) years of age, or older, I have read this document, and I UNDERSTAND THE CONTENTS.

____________________________________________

Signature Date

Signature of Parent or Guardian if under 19____________________________

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