Mail to:
HFAC
Attn: Rod Ilg, Race Director
4800 Bellknap Ct
Hillsboro, OR 97124

Event (Choose One)

Individual - Triathlon & Duathlon
TRI NorthWest members can deduct $5.00.
- Triathlon - $55 received by 4/28 Triathlon - $65 received after 4/28 Duathlon - $45 received by 4/28 Duathlon - $55 received after 4/28

Relay - Three Person (EACH PERSON MUST FILL OUT SEPARATE ENTRY FORM & ALL 3 MUST BE MAILED IN TOGETHER)
- Triathlon Team - $65 received by 4/28 Triathlon Team - $75 received after 4/28 Duathlon Team - $55 received by 4/28 Duathlon Team - $65 received after 4/28

First Name / MI / Last Name

Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy (not 2008)

Age

Gender
- Female Male
Phone

Email

Division (Individual)

- 12 - 14 years 15 - 17 years 18 - 19 years 20 - 24 years 25 - 29 years 30 - 34 years 35 - 39 years 40 - 44 years 45 - 49 years 50 - 54 years 55 - 59 years 60 - 64 years 65 - 69 years 70 - 74 years 75 - 79 years 80 years & over
Special Divisions (Applies to Individuals ONLY)

- Clydesdales (males 198lbs and over) Athena (females 150lbs and over)
RELAY MUST COMPLETE* (Combined three ages-if two on a team, add the persons age twice that is doing the two disciplines)
* TRIATHLON DIVISION
- 105 & Under - All Men 105 & Under - All Women 105 & Under - Mixed 106 & Over - All Men 106 & Over - All Women 106 & Over - Mixed
* DUATHLON DIVISION
- 70 & Under - All Men 70 & Under - All Women 70 & Under - Mixed 71 - 90 - All Men 71 - 90 - All Women 71 - 90 - Mixed 91 & Over - All Men 91 & Over - All Women 91 & Over - Mixed
* Team Name (20 characters or less)

* Teammates Names:

Swimmer

Biker

Runner

T-Shirt Size (included with race entry fee)
- S M L XL
ESTIMATED 500-YARD SWIM TIME (individual Triathletes must provide answer):

ChampionChip Number (if applicable - Example - CE12345)

TRI NorthWest Membership # (if applicable) - members deduct $5.00

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 $30 replacement charge. The Entry Fee is Non-Refundable..

Type Full Name


Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)

Date________________________________________