1485 Duathlon entry form 19th. October

Image: Active Europe Logo

1485 Tri Club
No Frills
Duathlon Date 19/10/08
Venue at Market Bosworth Water Park
Start Time 10.30.am
5km run. 14 mile bike. 5km run
Entry Form

Name……………………………………..
Address………………………………………………………………………………
……………………………………………………………………………………….
Post code……………..
Tel………………………….. Mobile……………………
E Mail…………………………………………………………..
**Please provide e-mail if available to enable 1485 Tri Club to confirm race entry and send race details, results and photos.
Emergency Contact……………………………………………..
Tel………………………………………………………………
Cub………………………………………………………………
B.T.F. Number…………………
*BTA members must show valid membership at registration. Failure will incur non member day pass of £3
Sex M……. FM………
Date of birth…………………………Age at time of event……..
ENTRY FEE……………BTF £10 NON BTF £13 TOTAL…………
Please send this application form, plus your cheque (made payable to 1485 tri club) to
Duathlon …. Mr Steven Robinson
7 Tudor Close Market Bosworth warks CV 13 0NA. Tel 01455291230
Email doodlebug1485@hotmail.com
Cashing of your cheque confirms your entry to the race(s). You will also receive a confirmation e-mail or text where possible.
Entry confirmation and race details will be shown on the website one weeks prior to event date

Your details will be processed by 1485 tri club in full accordance with UK data protection legislation. 1485 tri club may contact you with information about other race events and services

. I agree that I participate in the stated event(s) entirely at my own risk and that no responsibility whatsoever shall attach to any event sponsors, race directors or any person involved in the organisation of the event(s) for any injury, accident, loss or damage suffered by me in, or by reason of, the event(s), however such may be caused. I am healthy and have no known medical condition that could make it dangerous for me to enter the event(s). I have read and understood the above.
Signed _________________________________________Date_____

www.1485-triclub.com