Receipt # ___________
Amt Pd ____________
Date ______________
Tech___Community___
Staff Initials
___________________
_
TEXAS TECH REC TRIATHLON
SPONSORED BY UNIVERSITY CUSTOM
SUNDAY, SEPTEMBER 25, 2016 7:30 am
INDIVIDUAL REGISTRATION
Children 12 and under must be accompanied by an adult on bike/run courses. To receive the Tech entry fee, SRC membership is required.
Division:
___Competitive
___Recreational
Gender:
___Men
___Women
Age Group:
(PLEASE CIRCLE)
Birthdate:
17 & under
40-44
18- 24
45-49
25-29
50-54
30-34
55 -59
35-39
60+ & 70+
______________ (mm/dd/yyyy)
Competitive
Rec
Swim
400 meters
300 meters
Bike
12 miles
9 miles
Run
2.5 miles
2 miles
1st place awards
No awards
Mandatory Packet Pick up:
Entry Fee: (Please circle)
Fri., 9/23
12 PM –7:00 PM
Tech:
$33 if received by Tues. 9/20
Sat., 9/24
10 AM - 4:00 PM
$43 after Tues., 9/20
R#_______________ ___ Race Check In and Numbering:
Community:
$43 if received by Tues. 9/20
(staff Initials)
Sun., 9/25
6:15AM – 6:45 AM
$53 after Tues., 9/20
Swimmers seeded fastest to slowest
No estimated swim time means
Entries received after Sept.20 may NOT be seeded you will be one of the last in the
water.
↓↓↓↓↓↓↓↓↓
Last Name___________________________First___________Estimated Swim Time:___________(400yds/300yds)
Street Address or PO Box_______________City_________________________State____Zip______
Phone # (_____)__________________E-Mail________________________
Emergency Contact____________________________Phone________________________
TEXAS TECH UNIVERSITY RECREATIONAL SPORTS TRIATHLON WAIVER, RELEASE AND INDEMNIFICATION FORM
(must be signed): In consideration of the acceptance of my entry in the TEXAS TECH UNIVERSITY RECREATIONAL SPORTS
TRIATHLON:
1. I hereby agree to comply with all the rules and regulations and event instructions of the TEXAS TECH UNIVERSITY
REC SPORTS TRIATHLON and its coordinators.
2. I do hereby release Texas Tech University, the State of Texas, the Board of Regents, employees, student employees and TTFCU and
its employees of all liability related to injuries or accidents to myself which may occur as a result of participation in the TEXAS TECH
UNIVERSITY REC SPORTS TRIATHLON.
3. I hereby acknowledge that I have sole responsibility for my personal possessions and athletic equipment during the TEXAS TECH
UNIVERSITY REC SPORTS TRIATHLON event, and its related activities.
4. I hereby acknowledge that there are always certain risks associated with any physical activity. I understand these risks and declare
myself physically sound and capable to participate in the TEXAS TECH UNIVERSITY REC SPORTS TRIATHLON.
5. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during
the TEXAS TECH REC SPORTS TRIATHLON event. No warranty as to the quality of medical care is being made.
6. I hereby permit the free use of my name and picture in broadcasts, telecasts and the press as they pertain to the TEXAS TECH REC SPORTS
TRIATHLON event.
7. I hereby agree that in the event of a race cancellation due to a storm, rain, inclement seas or weather, winds or other “Act of God”
conditions, my enrollment fee shall be non-refundable.
__________________________________________________________
DATE__________________________________
PARTICIPANT’S SIGNATURE
PARTICIPANTS UNDER 18 ARE REQUIRED TO HAVE A PARENT/GUARDIAN SIGNATURE
__________________________________________________________________
PARENT / GUARDIAN SIGNATURE
DATE__________________________________