Mail to:
Colville Parks & Rec
356 East Dominion
Colville, WA 99114

Event (Choose One)

Individual - Triathlon & Duathlon
(entry includes: Commemorative Technical Shirt, ChampionChip Timing, awards, prizes, Pre-Race Pasta Feed, lots of fun and camaraderie)
* TRI NorthWest members deduct $5.00 from entry fee.
- Individual - $65 received on or before 6/14 (deadline)

Relay - Three Person (EACH PERSON MUST FILL OUT SEPARATE ENTRY FORM & ALL 3 MUST BE MAILED IN TOGETHER)
(entry includes: Commemorative Technical Shirt, ChampionChip Timing, awards, prizes, Pre-Race Pasta Feed, lots of fun and camaraderie)
- Relay Member - $45 ppr received on or before 6/14 (deadline)

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)

- 19 Years & Under 20 to 29 Years 30 to 39 Years 40 to 49 Years 50 to 59 Years 60 Years & Over
RELAY MUST COMPLETE*
* TRIATHLON DIVISION (Combined three ages. If two on a team, take the person who is doing two disciplines and double it)
- 119 & Under - All Men 119 & Under - All Women 119 & Under - Mixed 120 & Over - All Men 120 & Over - All Women 120 & Over - Mixed
* Team Name (20 characters or less)

* Teammates Names:

Swimmer

Biker

Runner

Shirt Size - Technical T (included with race entry fee)
- S M L XL
ChampionChip Number (if applicable - Example - CE12345)

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

Post-Race Massage - 15 Minutes (add fees to entry fee)
- YES - Add $10.00 to Entry Fee
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/Non-Transferable.

Type Full Name


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

Date________________________________________