11th Annual Rec Your Body Indoor Triathlon SATURDAY, March 1, 2008; 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)
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