West Deptford Riverwinds Triathlon Registration

Fill this form out on-line then select the print button at the bottom of the page to print this form out to mail.

First Name: Last Name:

Address:

City:    State: Zip Code:

Phone Number:   Email:

Sex:                          Age:              Estimated swim time:

Emergency Contact:    Emergency Contact's #:

Event:                          T-Shirt Size:

Event:
Are you a USAT Member?Yes, If so what is your USAT Member Number?

No, Please enclose a $10 for one day insurance per person.

Make all checks/money orders Payable to: Living Proof Event Management, LLC.

Waiver and Release: Please Read Before Signing.

In consideration of the acceptance of my entry in the West Deptford Riverwinds Triathlon/Duathlon, I, my heirs, executors and administrators hereby discharge The Riverwinds Community Center, The town of West Deptford, National Park and Westville, The County of Gloucester, Living Proof Management, all sponsors and producers of the event, their agents, employees, volunteers, event directors, event holders and anyone associated in any way with the event, from all liabilities, actions, claims, demands, damages, costs and expenses which I may now or in the future have against them arising out of my participation in the above mentioned West Deptford Riverwinds Triathlon/Duathlon, including but not limited to all injuries that may be suffered by me. I attest that to the best of my knowledge, my physical condition and fitness are adequate for me to safely compete in the triathlon/duathlon. I acknowledge that my entry fee is non-refundable even in the event of the cancellation of the triathlon/duathlon. I further grant all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for legitimate purposes.

This year's race is going to be an age group start. No estimated swim times are necessary.

Signature:____________________________________________                                          Mail To: Riverwinds

Date:_________________________________________________                                                          PO Box 555

                                                                                                                                                       Collingswood, NJ 08108