2003 Fleet Feet Sports SuperSprint Triathlon Entry Form

2003 ENTRY FORM - - Fleet Feet Sports SUPERSPRINT TRIATHLON - - 2003 ENTRY FORM

Make check payable to: CAPRI EVENTS Send with signed entry to: CAPRI Events - P.O. Box 577490 Chicago, IL 60657-7490 NO REFUNDS OF ENTRY FEES. US FUNDS ONLY.	Events could fill at any time. To confirm that a race is still open visit www.Chicago Triathlon.com	NOTE 1: THERE IS A $25 CHARGE TO CHANGE EVENT OR DIVISION. NO DIVISION CHANGES WILL BE ALLOWED AFTER 7/15/03. NO EXCEPTIONS. NOTE 2: THERE IS A $25 CHARGE TO TRANSFER AN ENTRY TO ANOTHER INDIVIDUAL. NO TRANSFERS AFTER 7/15/03. NO EXCEPTIONS.	OFFICE USE ONLY

			THIS FORM MAY BE COPIED.

FIRST NAME

LAST NAME

STREET ADDRESS

CITY

STATE

ZIP

Age on
Race Day:

Birth
Date:

Sex:

Membership in USA Triathlon or a
USAT one-day permit is required for participation
in the Harbor Lights Sprint Triathlon.

I will be a current USAT member on race day. My 6 digit member
number is: __ __ __ __ __ __. I will show my card at race packet pick-up.
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.
I do not wish to join USAT and will pay the indicated race fee
that includes the single event permit fee.

For USAT information visit www.USATriathlon.org.

ChampionChip Timing:
I will Supply my own chip. CHIP CODE:

T-Shirt Size:

Number of Past Triathlons: _______

In Case of Emergency Call:
Name: ____________________ Relationship:__________

Phone: (___) __________________

Medical problem. Please
attach an explanation.

Longest Distance to Date: Sprint International 1/2 Ironman Ironman
Work Phone: (_____) ___________________
Home Phone: (_____) __________________
E-mail: ________________________________________
Company: _____________________________________

Occupation: ___________________________________

Leukemia & Lymphoma Society Contribution

I have included my tax deductible donation to the Leukemia & Lymphoma Society of America in the amount of:

$10

$20

$50

Other _______

ENTRY FEES (NO REFUNDS)
Please check one	Have USAT License	ADD USAT Permit
Fleet Feet Sports SuperSprint Triathlon
Open / Age Group	$ 48	$ 57
Individuals only, 15 years & older (375m Swim, 10k Bike, 2.5k Run)

1/2 Price Subscription to Triathlete Magazine

YES! Send me one year (12 issues) of Triathlete Magazine. I've included the 50% off subscription payment of just $21.95 with my race entry fee. Good on new subscriptions OR for renewals.

READ CAREFULLY BEFORE SIGNING: I acknowledge that prior to completing registration at the MultiSport Expo, I will be required to show proof of identification and proof of current USAT membership or a receipt for a one day permit and sign the Chicago Triathlon Acknowledgement Waiver and Release From Liability form. I also acknowledge that I am aware that failure to do so at the time of registration will disqualify me from competing in the event. I also acknowledge that there are no refunds. Transfer of an entry to another individual is at the discretion of CAPRI Events, certain restrictions may apply.

Signature __________________________ Date ________	Parent's Signature __________________________ Date ________ If participant is under 18 as of 7/20/03
CODE: web-super