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MAIL WITH ENTRY FEE TO: TRUE GRIT TRIATHLON, P.O. BOX 696, RIDGWAY, CO 81432 (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 #____ Total = $_________ FOR TEAM MEMBERS: Team Name__________________________________ Will you: ; Swim ; Bike ; Run ENTRY FEE: Each team member must fill out separate forms (circle one): Individual "USAT" Member $40.00 Individual Non-Member $45.00 Team "USAT" Member (each) $30.00 Team Non-Member (each) $35.00. Late entries made within 7 days of the race add $10.00. 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 against participation by a qualified health professional. 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, or anyone else who might claim or use 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 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 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 activity, facility or area, c)I WAIVE, RELEASE, AND DISCHARGE from any and all claims, losses, or liabilities for death, personal injury, partial or permanent disability, property damage, medical or hospital bils, theft, or damage of any kind, including economic losses, which may in the future 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, EVEN IF SUCH CLAIMS, LOSSES, OR LIABILITIES ARE CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OF THE PERSONS I AM HEREBY RELEASING; OR ARE CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OF ANY OTHER PERSON OR ENTIRY, 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. 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 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 the persons or entities mentioned above in paragraph (c) or of other persons or entities e)I AGREE NOT TO SUE any of the persons or entities mentioned above in paragraph (c) for any of the claims, losses or liabilities that I have waived, released or discharged herein: and f) I INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned above in paragraph (c) from any and all claims made or liabilities assessed against them as a result of (i)my actions or inactions (ii)the actions, inactions or negligence of others including those parties hereby indemnified; (iii) the conditions of the facilities, equipment, or areas where the event or activity is being conducted; (iv) the Competitive Rules; or (v) any other harm caused by an occurrence related to a "USAT" sanctioned event: and (g) I GRANT PERMISSION for the ue of my name and/or likeness relating to my participation in a USAT sanctioned event, and I WAIVE all right to any future compensation to which I may otherwise be entitled as a result of the use of my name or likeness. |
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( ) 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:_________________________ |
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For further information call: (970) 626-2007 or e-mail: triathlon@independence.net Additional information and forms can be found at: www.independence.net |