Henderson Harbor Triathlon 2005

ENTRY APPLICATION
Please print this application, fill it out, and send it in, with your entry fee. Thank you.

Iron Person

Team Swimmer
Name______________________________
Address____________________________
City ____________State ___Zip________
Phone(____)_________ Sex M F
Age on 7-16-05_____Birthdate________
T-shirt size____ E-Mail_______________		 Name______________________________
Address____________________________
City _____________State ___Zip_______
Phone(____)____________ Sex M F
Age on 7-16-05______Birthdate_________
T-shirt size____ E-Mail________________
Team Cyclist Team Runner
Name______________________________
Address____________________________
City ______________State ___Zip_____
Phone(____)____________ Sex M F
Age on 7-16-05______ Birthdate _______
T-shirt size_____ E-Mail_______________		 Name______________________________
Address____________________________
City ______________State ___Zip______
Phone(____)____________ Sex M F
Age on 7-16-05______Birthdate________
T-shirt size_____ E-Mail_______________
 

Fees:
Postmarked by 6/16/05: $35 Iron person, $60 Team                 Postmarked after 6/16/05: $40 Iron person, $75 Team
Race Day: $45 Iron person, $90 Team
The Henderson Harbor Triathlon 2005 will be utilizing chip timing for this years race.  For this reason, you must remember to return your chip at the finish line.  You cannot use this chip at other races and, should you fail to return your chip, you will be charged a $100 replacement fee.  **You are responsible for the return of your chip** Initial:_________

In signing this entry, I for myself, my heirs, executors and administrators, waive and release any and all claims for personal damage I may have against the sponsors of this and all cooperating municipalities organizations or their agents.
Iron person Signature_______________________ Swimmer Signature________________________
Cyclist Signature__________________________ Runner Signature__________________________
Parent or Guardian Signature for entrants under 18 __________________________________________

Make check payable to: 
CHJC/CREDO Triathlon
Canadian Residents, Money at Par

Mail entry forms to:
Henderson Harbor Triathlon
PO Box 468
Henderson Harbor, NY 13651

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