9th Annual Rec Your  Body Indoor Triathlon
February 12, 2006; 9AM Start
SIUC Student Recreation Center
Carbondale, IL


Last Name  _____________________________ 

First Name ___________________


Address: __________________________________   City __________ 

State _____  Zip ______


Day Phone (___) ___________  Date of Birth ______________ 


Age on Race Day ______     Sex  M ____  F ____


Please Check One According to Swimming level:
Beginner  ____         Intermediate ____    Advanced triathlete _____


Entry Fee        ________ $  10.00 SIUC Students and Student Recreation Center pass holders
                      ________ $15.00 others

Optional Event T-shirt   _______ $10.00

Indicate size   M ___   L ____ XL ____


Total enclosed         $_______


Make checks payable to SIUC.  Mail your entry to Cay Gerlock, Triathlon Club, 1104 Marion St, Carterville, IL 62918.


PLEASE READ THE FOLLOWING INFORMATION CAREFULLY.  SIGN IT ONLY IF YOU
AGREE TO THE TERMS.  FAILURE TO SIGN RESULTS IN LOSS OF PARTICIPATION RIGHTS.

By signing this waiver and release, I am aware that sporting and athletic activities
as undertaken by the Southern Illinois University at Carbondale Triathlon Club involve physical exertion, specialized skills including: swimming, biking & running. 
I understand that participation in these activity carries with it inherent risks.  I
understand that these risks include but are not limited to accidents resulting in
debilitating injury, loss of personal property and death.  I understand that I am
responsible for my actions during these club activities.  I understand that I agree
to abide by all rules of safety and conduct as set forth by Southern Illinois University at Carbondale Triathlon Club.  I understand that the Board of Trustees of Southern Illinois University, its employees and agents, and Triathlon Club
officers and all other race sponsors are not responsible for loss of property, injury
or death that occurs during the course of this Triathlon Club event.  I grant permission to all of the aforementioned to use any photographs, motion pictures,
recordings, or any other record of this event for any legitimate purpose. I affirm that I am voluntarily signing this agreement, without any promises having
been made to me for doing so. I have read this form and agree to the terms
and conditions herein.


____________________________  _____________________________    ___________
Participant's Signature       Parent's/Guardian Signature                                    Date
                             (For participants under 18 years of age
                             Parent/Guardian must be present during
                             the event)