TRUE GRIT TRIATHLON

(please type or print)

Name:_________________________________________________________________________________________

(Last) (First) (M.I)

Address:_________________________________________ City:____________________ State:____ Zip:_______

Phone: Day( )_____________ Night( )________________ e-mail ___________________________________

Age on race day:_______ Male_____ Female_____ USA Triathlon# ____________________________

Shirt Size (circle one): MED LG XLG Pasta dinner: Adult @$7.00 #____ Children @$5.00 #____

FOR TEAM MEMBERS: Team Name__________________________________ Will you:  Swim  Bike  Run

Total Enclosed:______________ (Please make checks payable to the: True Grit Triathlon)

All competitors must currently be members of the "USA Triathlon" or purchase one-day "USA Triathlon" insurance prior to the race registration deadline. For each entrant who is NOT a member of the "USA Triathlon", an additional $5.00 insurance fee HAS BEEN ADDED to the NON-MEMBER entry fee.

SIGNATURE:__________________________________________ DATE:_______________________

ALL ATHLETES MUST READ AND SIGN. PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGEMENT WAVER AND RELEASE FROM LIABILITY (AWRL).

I acknowledge that a Triathlon or bi-sport 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 BI-SPORT EVENTS. 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 acknowledge that my statements on this AWRL are being accepted by the "USA Triathlon" ("USAT") in consideration for allowing me to become a member in "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: a) I AGREE to abide by the Competitive Rules adopted by "USAT", including the Medical Control Rules, as they may be amended form time to time, and I acknowledge that my membership may be revoked suspended for violation of the Competitive rules: b) I WAIVE, RELEASE, AND DISCHARGE from any and all claims or liabilities for death, personal injury, property damage, theft or damages of any kind, which arise out of or relate to my participation in, or my traveling to and from a "USAT" sanctioned event, THE FOLLOWING PERSONS OR ENTITIES: "USAT", event sponsors, race directors, event producers, volunteers, all states, cities, counties or localities in which events or segments of events are held, and the officers, directors, employees, representatives and agents of any of the above: c) I AGREE NOT TO SUE any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein: and d) I INDEMNIFY AND HOLD HARMLESS persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions during a "USAT" sanctioned event.

( ) I HEREBY AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER. I HAVE READ THIS DOCUMENT, AND I UNDERSTAND ITS CONTENTS.

SIGNATURE:___________________________________________ Date:_________________________

MAIL WITH ENTRY FEE TO: TRUE GRIT TRIATHLON

P.O. BOX 696

RIDGWAY, CO 81432

For further information call: (970) 626-2007 or e-mail: triathlon@independence.net

Additional information and forms found at: www.independence.net