======================================================================== North Mankato Triathlon ======================================================================== Full Name _____________________________________________________________ Address _____________________________________________________________ City _________________________ State _____ Zip Code ___________ Email _____________________________________________________________ Phone (______) ________-___________ Age on race day ______________ Sex _____ Male _____ Female Date of birth ________________ Division Men __12-19 __20-29 __30-35 __36-44 __45-54 __55-64 __65 & Over Women __12-19 __20-29 __30-35 __36-44 __45-54 __55-64 __65 & Over ------------------------------------------------------------------------ Relay Team: All members must sign below Shirt size ------------------------------------------------------------------------ Swim ___________________________________________________ S / M / L / XL Bike ___________________________________________________ S / M / L / XL Run ___________________________________________________ S / M / L / XL ------------------------------------------------------------------------ Disclaimer ------------------------------------------------------------------------ Knowingly and at my own risk, I hereby apply to enter the North Mankato Triathlon and do hereby waive and release any and all claims for damages that I may incur as a result of my participation in the event against all sponsors or any employee, volunteer, official, or elected official of these organizations for said injuries. I further hereby certify that I have full knowledge of the risks involved in this event, and I am physically fit and sufficiently trained to participate. If however, as a result of my participation in the North Mankato Triathlon, I require medical attention, I hereby give my consent to authorized medical personnel of said triathlon to provide such medical care as deemed necessary by such authorized personnel. PARTICIPANT SIGNATURE(S) __________________________________________ PARENT/GUARDIAN SIGNATURE(S) __________________________________________ If participant(s) is/are under 18 years old Shirt S / M / L / XL (Must be present to receive shirt) Please mail this entry form and a check payable to: NORTH MANKATO TRIATHLON c/o Ann Vose 2220 West Dream Drive North Mankato, MN 56003