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Official My First Triathlon Entry Form

Saturday August 23, 2003
Parksville, British Columbia
Start Time 5:00 PM

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

Parksville Fees:

Early July 10th $79.00

Regular July 30th $89.00

Late After July 30th $99.00

Total Enclosed $ ____________

The fees are to encourage athletes to sign up early so we know how many medallions and shirts to order and to prepare the race venue, and commits you to train. No refunds or exchanges. Cancelled check confirms entry.

Make cheque/money order payable to: Canadian Endurance Sport

Mail completed entry forms (Front And Back) to:

My First Triathlon

c/o World Endurance Sport

PO Box 3572 Vancouver, B.C. , Canada V6B 3Y6

Entries may also be dropped off at the following location: Joma Sport, 1711 Fir Street, Vancouver(Kits),B.C.

Visit Triathlons.net or CayuseSport.com for more locations

Athlete Questionaire

Did you pick your weekend on front of this form? Yes___No___

If you answered No please ensure you picked your weekend prior to sending this form in.

How/Where did you hear about 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 2003, Event Sponsors, Event Directors, Event Producers, Event Workers and Volunteers, Event Connected charities, and all cities, countries, districts, public agencies and /or states 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 Triathlon 2003 (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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