
SCOGGINS VALLEY TRIATHLON & DUATHLON Entry Form
Saturday, September 4, 2010
Hagg Lake Lake Park, Forest Grove, OR
Sprint Distance Tri*: Tri-it Tri: Olympic Distance
Du*: Olympic Distance Tri*:
www.racecenter.com/scogginsvalley
email: events@racecenter.com
*TRI NorthWest Ranked (Tri's & Du)
Instructions
> Type in your information in the
blanks provided.
> Print entry form & SIGN WAIVER (Entry will not be
accepted without the signed waiver)
> Make Checks Payable to:
Scoggins Valley Triathlon
Mail to:
AA Sports, Ltd.
4836 SW Western Ave
Beaverton, OR 97005
PACKET
PICKUP: See event Web site for details
Event (Choose One)
Individual
- Triathlon & Duathlon
(entry includes: T-shirt, Day Use Park Pass, ChampionChip Timing, awards,
prizes, food, festivities, and great camaraderie. (TRI NorthWest members
deduct $10.00 from entry fees)
Relay - Three Person
(EACH PERSON MUST FILL OUT SEPARATE ENTRY FORM & ALL 3 MUST
BE MAILED IN TOGETHER)
T-Shirt
Size (included with entry fee)
ChampionChip Number (if applicable
- Example - CE12345)
TRI NorthWest Membership # (if applicable) - Members
can deduct $10.00 from 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.
Type Full Name
Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of
18)
Date________________________________________