Mail to:
Troika Triathlon
PO Box 21065
Spokane, WA 99201

Event (Choose One)
Individual
- Half-Iron Tri - Individual (before May 31) - $125.00 Half-Iron Tri - Individual (between May 31 - June 29) - $140.00 Half-Iron Tri - Individual (After June 30) - $165.00

Relay (all three team entries must be mailed together)
- Two Person Relay (before May 31) - $140.00/per team Two Person Relay (after May 31 - June 24) - $160.00/per team Two Person Relay (after June 24) - $190.00/per team Three Person Relay (before May 31) - $210.00/per team Three Person Relay (after May 31 - June 24) - $240.00/per team Three Person Relay (after June 24) - $285.00/per team

*Shuttle Bus to Medical Lake (Red Lion at the Park to Medical Lake, departs at 5:30am)
- YES - ADD $10 to entry fee

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

EMERGENCY CONTACT
NAME

PHONE

Division (Individual)

- 16 - 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 - 84 years 85 years & over
Special Divisions (Applies to Individuals ONLY)

- Clydesdales (males 198lbs and over) Athena (females 150lbs and over)
RELAY MUST COMPLETE*
* Division (Combined three ages. If two on a team, take the person who is doing two disciplines and double it)
- 105 & Under - All Men 105 & Under - All Women 105 & Under - Mixed 106 & Over - All Men 106 & Over - All Women 106 & Over - Mixed
* Team Name (20 characters or less)

* Teammates Names:

Swimmer

Biker

Runner

T-Shirt Size (Long Sleeved for Relays only)
- M L XL
Sweatshirt Size (Individuals only)
- M L XL
Estimated Completion Time

ChampionChip Number (if applicable - Example - CE12345)

TRI Northwest Membership # (deduct $5.00 from Entry):

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________________________________________