Entry Form
Firecracker Triathlon/Duathlon, Kid's mini-tri & Footraces - Friday July 4, 2008
Mail completed entry form and fee to: Firecracker Triathlon/Duathlon, Kid's mini-tri & Footraces, @ 9435 180th Way Sw, Rochester, WA 98579, Elma, WA
(Please print)

Name (first)                           (last)
|__|__|__|__|__|__|__|__|__|__|__|__|  |__|__|__|__|__|__|__|__|__|__|__|__|
Address
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City                                   State         Zip
|__|__|__|__|__|__|__|__|__|__|__|__| |__|__| |__|__|__|__|__|
Phone                                      Sex        Age on Race Day
|__|__|__| |__|__|__| |__|__|__|__|       M    F         |__|__|

FEES: (Entries include T-shirt):

Triathlon (Before June 16)             $45.00  $ ______
Triathlon (Before June 28)             $48.00  $ ______
Triathlon (Before July 4)              $50.00  $ ______
Triathlon day of race                  $55.00  $ ______
2/3 person tri team (Before July 4)    $60.00  $ ______
2/3 person tri team day of race        $70.00  $ ______
Duathlon (Before June 16)              $35.00  $ ______
Duathlon (Before June 28)              $38.00  $ ______
Duathlon (Before July 4)               $40.00  $ ______
Duathlon day of race                   $45.00  $ ______
2/3 person du team (Before July 4)     $40.00  $ ______
2/3 person du team day of race         $50.00  $ ______
Kids mini-tri (Before July 4)          $18.00  $ ______
Kids mini-tri day of race              $20.00  $ ______
15K ( 9.3 miles) (Before July 4)       $30.00  $ ______
15K day of race                        $35.00  $ ______
10K (6.2 miles) (Before July 4)        $25.00  $ ______
10K day of race                        $30.00  $ ______
5K (3.1 miles) (Before July 4)         $20.00  $ ______
5K day of race                         $25.00  $ ______
1 mile day of race                     $15.00  $ ______
Kids dash 1/4 to 1/2 mile              $15.00  $ ______
            No shirt option            -$5.00  $ ______
        Upgrade to tank top            $10.00  $ ______
        Upgrade to longsleeve          $10.00  $ ______
        Extra short sleeve              $7.00  $ ______
        Extra tank top                 $12.00  $ ______
        Extra longsleeve               $13.00  $ ______

T-shirt Size (circle one): 
Adult S  M  L  XL   XXL
Child S  M  L  XL   XXL

TOTAL ENCLOSED                                 $ ______

MAKE CHECK PAYABLE TO: Kristina Salazar, 9435 180th Way Sw, Rochester, Wa 98579

Waiver I HEREBY RELEASE THE PUGET SOUND CRUISERS, THE CITY OF ELMA, THE COUNTY OF GRAYS HARBOR, THE STATE OF WASHINGTON, VANCE CREEK PARK, VOLUNTEERS, EMPLOYEES AND ANYONE ELSE INVOLVED IN THE ABOVE EVENTS. I KNOW I'M WAIVING MY RIGHTS TO SUE FOR ANY AND ALL REASONS, INCLU DING BUT NOT LIMITED TO PERSONAL INJURY OR DEATH. I HAVE TRAINED FOR THIS EVENT AND HAVE NO MEDICAL PROBLEMS. I ALSO KNOW MY ENTRY FEE IS NON-REFUNDABLE FOR ANY REASON AND I WILL NOT ASK FOR IT BACK. THE DECISION OF THE RACE DIRECTOR IS FINAL.

__________________________________________________________________
Signature of Athlete Date (Signature of Parent or Guardian if under 18 years)

For more information call 360-273-9684 or wanttoduit@hotmail.com

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