-
- - 2010 ENTRY FORM - - - Chicago Triathlon - - - 2010 ENTRY FORM - - -
Make
check payable to CAPRI Events. Send with signed entry to: Chicago Triathlon/Timberline Timing PO Box 609 Fort Collins, CO 80522-0609 NO REFUNDS OF ENTRY FEES. US FUNDS ONLY. Keep cancelled check as proof of payment. |
Events could fill at any time. To confirm race is open visit www.ChicagoTriathlon.com. YOU MUST CONFIRM MAILED ENTRIES AT www.ChicagoTriathlon.com |
NOTE
1: $25 CHARGE TO CHANGE EVENT OR DIVISION. NO
DIVISION CHANGES AFTER 7/1/10. NO EXCEPTIONS. |
|
| FIRST NAME | LAST NAME |
USA
Triathlon Membership or Permit required to participate in the Accenture Chicago Triathlon. For
USAT information visit www.USATriathlon.org.
| STREET ADDRESS |
I will be a current
USAT member on race day. I will show my card at race packet pick-up. My 6 digit member number is:__ __ __ __ __ __.
| CITY | ST | ZIP |
I will contact
USAT and become a new member by race day and will provide my member number & show my card at race packet pick-up.
| Age: | Birth Date: |
Sex: | M | F |
I do not wish
to join USAT and will pay the indicated race entry fee that includes the single-event permit fee of $10.
| Technical
Shirt Size: XS S M L XL XXL |
| Number of Past Triathlons: _____ Number of Past Chicago Triathlons: _____ |
| ChampionChip Timing: |
I will supply my
own chip. CODE: |
| Longest Distance to Date: Sprint International 1/2 Ironman Ironman |
| Work Phone: ( ) Home Phone: ( ) |
| Company: |
| E-mail: |
| Occupation: |
| Emergency Contact Name: Relationship: Phone: ( ) | Medical problem. Please attach explanation. |
I want to purchase the Custom ChampionChip and
have included $39.00 with my entry. [ For more information see the Triathlon Gear Page ]
I want to purchase the Custom Chip Strap and
have included $5.00 with my entry (strap will be in your race
packet at expo). I
have included my tax deductible donation to the Leukemia & Lymphoma Society of America in the amount of: $10 $20 $50 Other
_______ YES! Send me one year of Triathlete Magazine for $29.95, which is 15% off the subscription price of $34.95. Take advantage of Triathlete's specialoffer created for competitors like you, who are the heart of the sport. Subscribe, or extend your current subscription to Triathlete and save!
| PLEASE CHECK ONE | ||
Sprint
Distance (.75k
Swim - 22k Bike - 5k Run) |
USAT Member | Non-USAT Member (Includes permit) |
Open/Age Group |
$155 |
$165 |
Mountain
Bike |
$155 |
$165 |
International
Distance (1.5k
Swim - 40k Bike - 10k Run) |
||
Open/Age
Group |
$155 |
$165 |
| Mountain Bike | $155 |
$165 |
Clydesdale
/ Athena |
$155 |
$165 |
Elite Amateur Age Group |
$155 |
$165 |
| First Responder | $155 |
$165 |
Professional
Triathlete |
$155 |
$165 |
Relay
Team Competition (International Distance Only) |
||
Open Relay Team
Male Female Coed |
----- | $285 |
| Team Name: ________________________________________ | ||
Corporate Relay Team Male Female Coed |
----- | $300 |
| Company Name:________________________________________ | ||
Triple
Challenge |
||
Includes
the Fleet Feet Sports SuperSprint Triathlon, the Sprint and International Distance of the Chicago Triathlon. Must be memberof USAT to compete in this division. Info is available at USAtriathlon.org. |
||
| Open/Age Group | $300 |
----- |
| Mountain Bike | $300 |
----- |
READ
CAREFULLY BEFORE SIGNING: I
acknowledge that prior to completing registration at the Multisport and Fitness Expo, I will
be required to show proof of identification and proof of USAT membership
or receipt for a current USAT one-day permit and sign the Chicago Triathlon
Acknowledgement Waiver and Release From Liability form & Event
Swim Waiver form. I also acknowledge that I am aware that failure to
do so at time of registration will disqualify me from competing in
the event. I also acknowledge that there are no refunds. Transfer of
an entry is at the discretion of CAPRI.
Signature ______________________________ Date ________
Signature ____________________________ Date ________
If participant is under 18 as of 8/29/2010 (Chicago Triathlon).