Register on-line at www.active.com
or download & mail entry form: Print Entry Form
July 7, 2007
North Bend State Park - Cairo, WV
REGISTRATION FORM
________________________________________________________________________________
NAME AGE
____________________________________________________________________________________________________
ADDRESS
____________________________________________________________________________________________________
CITY STATE ZIP CODE
_______________________________________________ ____________________________________________________
PHONE E-MAIL
I will be participating in the (mileage is approximate and subject to change):
Entry Fee: Postmarked by June 8, 2007: $30, after: $40.
q Texas Roadhouse You’re DARN TOOTIN’ I Did a Triathlon Triathlon
(1 mile run, 2 mile paddle, 3.3 mile mountain bike) 10 am*
q MCCarter Chiropractic Mud, Sweat, and Chaffed Buns Triathlon
(4.25 mile run, 4 mile paddle, 6 mile mountain bike) 10 am*
Entry Fee: Postmarked by June 8, 2007: $45, after: $55
q St. Joseph’s Extreme Torture Challenge Triathlon (10.5 mile run, 6 mile paddle, 20 mile mountain bike) 8 am*
Entry Fee: Postmarked by June 8, 2007: $10, after: $15. Additional child $5 anytime.
q Lowell Warden Jr. Memorial Children’s Triathlon (2)
(1/4 mile run, 200 yard paddle, 1 mile bike) 2 pm*
(Pee Wee: 100 yard paddle w/ adult, 200 yd bike gravel/pavement, 100 yd run) 2 pm*
I will compete in the category selected: Please enter me in the:
q Individual – female □ Athena division - female 150 lb+
q Individual – male □ Clydesdale division – male 200 lbs+
q Team name: ______________________________
(Registration form and fee required for each team member.)
T-shirt size: sm, md, lg, xl, 2x
Kayaks and canoes are not provided as a rule but can be made available if needed. Certain conditions apply. Equipment available for $10/day with paid registration -first come first served.
q Yes, I am interested in having equipment provided for an additional $10 paid with this registration.
Please contact me so we can work something out.
q Nope, I have my own awesome gear.
*Time: Mandatory race meeting at 7:15 for extreme, 9:15 for beginner & intermediate and 1:45 for children. Mandatory race meeting also held Friday night at 7 pm if would like to attend then instead.
Lodging: Lodge Rooms: Contact the park directly (304-643-2931 or 1-800-CALL-WVA & ask for North Bend)-mention “Adventure Pursuit” for access to the block of rooms we have reserved. SPACES ARE LIMITED! For local hotel info, visit www.runbikekayak.com.
Primitive camping in “Athlete’s Village” is also available for $12/night and can be reserved with this registration form.
q Please reserve a campsite for Friday night. My $12 is included in this registration.
q Please reserve a campsite for Friday & Saturday nights. My $24 is included in this registration.
Total Fees Included with this registration: $_______
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Thanks to our sponsors!: North Bend State Park, St. Joseph’s Hospital, McCarter Chiropractic, Texas Roadhouse, Woodcraft, Steve Reger, Roberts Family Photography, Vienna Bike Shop, Stonewall Marketing, Momentive, Simonton Windows ,North Bend Outfitters, Pressley Ridge, Ritchie Co Emergency Services, REACT, Shiloh Trail riders, Jackson Kelly, Dovetail Solar & Wind, Hanger Prosthetics, Bryan Katchur |
Waiver of Liability (Must be signed by all participants)
By signing this form, I acknowledge that the events of Adventure Pursuit’s Triathlon are inherently dangerous and I fully assume the risks associated with bicycling, canoeing, kayaking and running. In consideration of the acceptance of this entry, I, the undersigned, intending to be legally bound hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Adventure Pursuit, North Bend State Park and any other sponsors and their representatives, successors and assignees, for any and all claims or liabilities of any kind arising out of my participation in this event. I further attest that I am physically fit and sufficiently trained for the triathlon. The Organizing Committee reserves the right to refuse any entry. I agree to abide by the race rules established by the Organizing Committee, including but not limited to:
• All cyclists are required to wear helmets during the cycling portion of the competition;
• All boaters are requires to wear personal flotation devices during the canoe/kayak portion of the competition;
• All competitors are expected to observe the appropriate rules of the road and exercise reasonable caution and common courtesy; and
• Competitors must stay on the race course for all events.
• Any pictures taken of me are available for use.
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PRINT NAME DATE
____________________________________________ ________________________________________________
SIGNATURE SIGNATURE OF PARENT/GUARDIAN (if participant is under 18)
How/where did you hear about the race? ________________________________________
If referred or dared by a friend, which friend? _____________________________________
Mail entry form to
Adventure Pursuit
PO Box 431
Parkersburg, WV 26102
Register on-line at www.active.com.
Credit Cards Accepted. Fees are non-refundable.
Please feel free to contact us for more information at (304)485-0911 or email adventurepursuit@hotmail.com Organizers reserve the right to cancel race based on weather and/or conditions.
For up to the minute information about the race, visit www.runbikekayak.com |