Mail
to:
NWCPRD
414 Washington, Suite 1D
The Dalles, OR 97058
Event (Choose One)
Individual
INDIVIDUAL (entry includes: Commemorative T-Shirt, ChampionChip Timing,
awards, prizes, food, festivities, and great camaraderie)
TRI NorthWest members can deduct $5.00.
First Name / MI /
Last Name
Street Address
City
State/Province
Zip/Postal Code
Birthdate - mm/dd/yy (not 2008)
Age
Gender
Phone
Email
Division (Individual)
Special Divisions (Applies to Individuals ONLY)
T-Shirt Size (included
with race entry fee)
ChampionChip Number (if applicable - Example - CE12345)
TRI NorthWest# (if applicable - decuct $5)
I WOULD LIKE TO PURCHASE GUEST LUNCH TICKETS
Check#
Amount Enclosed
WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I acknowledge that a Multi-Sport Event is an extreme
test of a person's physical and mental limits and carries with it the
potential for death, series injury, and property loss. I HEREBY ASSUME
THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am capable
of completing all disciplines of the event, and that I am physically fit
and that I have sufficiently trained. I agree to abide by the competitive
rules. I hereby take the following action for myself, my executors, administrators,
heirs, next to kin, successors and assigns, or anyone else who might claim
or sue on my behalf, and I hereby waive, release and discharge from any
and all claims, losses, or liabilities for death, personal injury, partial
or permanent disability, property damage, medical or hospital bills, or
theft which may arise out of or relate to my participation in this event.
I agree not to sue, and to hold harmless any and all persons, sponsors,
volunteers, participants or government agencies for any and all claims
or liabilities that I have waived, released or discharges herein. I
further agree to return the timing Chip that is been issued to me or to
pay a $20 replacement charge. ENTRY FEES ARE NON-REFUNDABLE.
Type Full Name
Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age
of 18)
Date________________________________________