Tupper Lake Tinman Triathlon - Entry Application 
June 26, 2010

Deadline June 4rd (This race is subject to close earlier than deadline if max applications are received)

$10 One Day Fee ________
USAT #    _____________ (USAT Card must be shown at Registration or $10 one day fee will apply to all not showing a card. Canadian cards are not accepted by USAT

LAST NAME: ______________________ FIRST NAME: ________________________

MAILING ADDRESS: ____________________________________________________

CITY:__________________________________________________________________

STATE: ____________ ZIP: _______________ DAY PHONE: ____________________

EMAIL: _____________________________________ DOB: _____________________

M OR F _______ Age end of 2010: ______T-SHIRT SIZE (s,m,l,xl)_______________

EMERGENCY CONTACT NAME & NUMBER: _______________________________

MEDICAL PROBLEMS Y OR N   EXPLAIN: _________________________________

RACE STATUS (circle one)

TINMAN //// SPRINT /// /TEAM/// PHYSICALLY CHALLENGED

Please Print an Application for each team member to fill out

(ALL TEAMS MUST PROVIDE THE ABOVE INFORMATION FOR EACH MEMBER OF YOUR TEAM with A New Application for each team member.)

Team Name Only if registering for a Team: __________________________________

Challenged Division: Please Explain: _______________________________________

 

All entry fees include T-Shirt, carbo-dinner, post race dinner, swim caps and information in your race packets. Race packets will be handed out at Registration on June 26, 2010. Time of Registration is 10 am to 9 pm. Carbo-Dinner will begin at 4 pm and end at 8:00 p.m. You can check the entry list on our website at: www.tupperlakeinfo.com or phone: (518) 359-3328. No conformation packets will be sent by mail. No one is allowed to pick packets up for anyone other then yourself.

                All Entry Fees are Non Refundable & Non Transferable

 All Checks/Money Orders MUST be in U.S. FUNDS or your check will be returned to you

Help the Tupper Lake Tinman Triathlon and the community that supports us. In this, our 27th race, we are raising money to fund a scholarship for a local high school senior going on to study sports medicine. We are also hoping to raise enough money to make some improvements to the race like new Swim/Transition equipment. Thank you for your consideration. Every little bit helps!!

If you are interested, enter a donation amount here:

$

Make Checks Payable to Tupper Lake Tinman

Mail to Race Director:

Michele Cote Tinman Triathlon

92 Ivy Terrace, Tupper Lake, NY 12986

Race Type

Entry Fee

Late Fee   (starting April 1st 2010

Tinman

$142.00

$175.00

Teams

$210.00

$250.00

Sprint

$ 120.00

$145.00

Donation Amount:

_________

 

 Entry Fee:

_________

 

 $10 One Day :

_________

or USAT # ____________

Total Sent:

_________

 

 

Please read: In consideration of you accepting this entry. I, the undersigned do hereby waive and release the Tupper Lake Chamber of Commerce, sponsors, officials and municipalities through which the race is run, from all liabilities and claims arising from my participation in this race. I grant permission to use photo’s videos, or any other records of this race from any legitimate purpose. I understand that the use of headphones during the race is prohibited. I attest that I am physically fit and have sufficiently trained for this race.  

 

Participant Signature:

Date: