Sunday, July 12, 2009 -- Richwood, WV / Summit Lake - Monongahela National Forest
24th Annual Scenic Mountain Triathlon ENTRY FORM (iPO Event Id#: 12018) --- Return to the Details Page

Please Mail and Make Checks Payable to:
RICHWOOD AREA CHAMBER OF COMMERCE, P.O. Box 267, Richwood, WV 26261

For Additional Information Call: (304) 846-6790 or rwdchamber@richwoodwv.com

REGISTRATION FORM
(Please print application and mail to address below. Pre-Registration is due by June 27, 2009. When registering as a USA Tri-Member, you must have a valid Membership Card. For USA Triathlon membership applications call (719)597-9090. Registration fees are refundable up to the day of the event and nontransferable. If you have trouble printing from your internet browser, press "Ctrl A" to select all information on page; then press "Ctrl C" to copy all information from page; then open a blank page in Word or similar program; then press "Ctrl V" to paste information in Word or similar program; then press "Ctrl P" to print.)

Individual
TEAM: (circle one) Male Female Mixed Sex Age Shirt Size

NAME (individual or captain) __________________________________________

PHONE:______________________ E-MAIL:_____________________________

ADDRESS: ________________________________________________________

CITY: ______________________________ USAT # (if applicable)____________

STATE: _______________________________ ZIP CODE:__________________

If individual, supply Sex (Male or Female), Age_____, Shirt Size (S, M, L, XL)

TEAM NAME:______________________________________________________

List Member?s Names
Swim:___________________________, Sex (M or F), Age_____, DOB__________, Shirt Size (S, M, L, XL)
Bike:____________________________, Sex (M or F), Age_____,DOB__________, Shirt Size (S, M, L, XL)
Run:____________________________, Sex (M or F), Age_____,DOB__________, Shirt Size (S, M, L, XL)

REGISTRATION FEES ENCLOSED:

Pre-Registered # of Persons on Team ( )

$150.00 entry fee per team $________

Day of Race # of Persons on Team ( )

$165.00 entry fee per team $________

Pre-Reg. Individual USA Tri. Member Fee $60 $_____

Pre-Reg. Individual Non-member Fee $70 $_____

Day of Race Individual Member Fee $70 $_____

Day of Race Individual Non-member Fee $80 $_____

Note: Registration Fee includes T-Shirt, pasta dinner and cookout following race.

Pre Race Pasta Dinner # of Guest Tickets ( )

6:00-8:00pm, Saturday - July 11th, 2009 -Knights of Columbus Hall

Competitors and age 5 and under free/age 6 and over $6 each $_____

REGISTRATION AND DINNER TOTAL $________

Along with this entry form:

Please, review, print, sign and mail USATriatilon Waiver Form and visit USA Triathlon's web site!