Sunday, June 10, 2012 -- Uniontown, PA
Uniontown YMCA Sprint Triathlon
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RACE CONTACT: Bill Poninsky/Uniontown YMCA (phone) 724-438-2584 (email) billp@uniontownYMCA.org
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Individual Fee - $40 (postmarked on/before May 11) | $45 (on/before May 25) | $50 (after May 25)
Relay Teams - $65 (postmarked on/before May 11) | $70 (on/before May 25) | $75 (after May 25)
Mail to: Bill Poninsky, Uniontown Area YMCA, 1 YMCA Lane, Uniontown, PA 15401
Checks payable to: Uniontown YMCA
Name: _____________________________________________________________________
Address: __________________________________________________________________
City/State/Zip: ___________________________________________________________
Phone: (__________________)________________________________________________
E-mail: ___________________________________________________________________
Age on Race Day:_____ // Birthdate:_____/______/___________
PLEASE CHECK ONE!
Sex: Female___ / Male___ // Shirt Size: S___ M___ L___ XL___
Estimated Swim Time:________ // Est. Bike Time:________ // Est. Run Time:_________
Individual___ Male Relay___ Female Relay___ CoEd Relay___ Corporate Relay___
IF RELAY, Team Name: _______________________________________________________
*Team applications must be submitted together and each team member is required to complete and sign entry form!
WAIVER: In consideration of my entry being accepted in the Uniontown YMCA Triathlon race, I, intending to be legally bound, do hereby, for myself, my heirs, executors, and assigns, waive, release and forever discharge any and all rights and claims for damages that I may have or which may hereafter accrue to me against the Uniontown YMCA Triathlon, Uniontown Area YMCA, timing service, PennDOT, and all sponsors. I understand the difficulty of this event and attest that I am in good physical condition.
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Athlete Signature
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Date
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Signature of Parent or Guardian if Athlete under 18