Blackshots Swimming Pool
Stifford Clays
Grays
|
Sunday
22 July 2012
400m Swim
20k Bike
5k Run
|
|
Entry fee: £28 (£3 returned on day to those with BTF Membership Cards) payable to "East Essex Triathlon Club" (cashing of cheque is proof of entry). Prizes in All
categories Withdrawals
will be accepted up to 8 July and money returned (less £5 admin charge). For
withdrawals after this date money will be returned only if the place can be
filled. |
Send
completed form with cheque to:- Race Administrator Wilkins Kennedy Grays Tri 21 John William Close Chafford Hundred |
|
Closing
date – Friday 8 July 2012 (or when full) We
are restricted to a total of 250 competitors: in 2009 the race was full six
weeks prior to the race |
Tel: 01375 482 469 |
Bike Helmets are
Compulsory - No Helmet, No Race
Detach and
send the lower half of this form – retain the top half for your records.
-------------------------------------------------------------------------------------------------------------------------------
Wilkins
Kennedy Grays Triathlon 2012 - Event Application Form
Name:
____________________________________ Sex (Male / Female) ___ Tel No:
________________________
Date of Birth:
_______________________ Age as at 31 December 2012: __________ BTF No:______________
Address:
_________________________________________________________________
_____________________________________________________________
Post Code: ___________________
Club_____________________________________________
Estimated Swim
Email:
____________________________________________T Shirt size (S, M, L, XL) ____ (we
can only guarantee size for entries received before 1 July )
Disclaimer:
I declare that I will abide by the rules of the
British Triathlon Federation. I accept that I participate entirely at my own
risk and accept that the BTF, it’s agents, the event-organisers and their associates are not liable for any
loss, damage, claim, expense, injury or accidents which may arise as a
consequence of my negligence at this event. I will cycle with due care and
attention, abiding by the normal rules of the Highway Code and remain
responsible for my own property. I am in good health.
Signed:
________________________________________________ Date: ____________________
Youths/Juniors
welcome (age 15 by 31 Dec 12)
If under 18, to be signed by Parent/Guardian - please print name and
relationship
Name:
__________________________ Relationship: ____________________