CLEVEDON MARINE LAKE AQUATHLON
SUNDAY 30TH JUNE 2013 – 11.30 START
BRITISH TRI RULES, AFFILIATED TO ASA & BLDSA
First name: ……………………………….…...........................................................................................................………………
Surname: ……………………………………………............................................................................………………………...
Address: …………………………………………………………………………………………………………………
Postcode: ……………………………………………..……... Telephone: ……………………………………………..
Email: (please print clearly) ……………………………………………………………….……………………………
Date of birth: ……………………………………………..……... Age: …………………………………. Male/Female
Medical details we should be aware of (e.g. Asthma): …………………………………………………………………..
Team name (if applicable):……………………………………………………………………………………………….
(Each member of a team must submit a completed entry form)
British Tri/CASC Number ...................................................................................................................................................................
Category:( (AGE AS AT 31ST DECEMBER 2010)
Any mixed age or gender for the team event - please circle
Junior(12-16) Senior(17-39) veteran(40+)
Male Female Team (+ circle other info.)
Please circle the distance you wish to enter:
Swim 400m/Run 3k Swim 800m?Run 6kmm
Entry Fee: Juniors = £ 9.00
Seniors & Veterans = £15.00
Team (Senior or mixed Snr/Jnr) = £22.00
Junior Team (if both Jnr) - £16.00
Bri. Tri/CASA member = £ 2.00 reduction £1.00 team
Enteries will be accepted on the day = £ 2.00 per person extra (Latest entry time will be 10.45am)
IF YOU ENTER BEFORE APRIL 2013 PLEASE DATE YOUR CHEQUE 8TH APRIL 2013
Declaration
I declare that I will abide by the regulations governed by the organisers and accept that the event organisers and their associates are not liable for any loss, damage, claim or expense which may arise as a consequence of my participation in this event/these events. I agree to abide by ‘British Triathlon Rules’, copies of which are available on web.
I am of good health and compete at my own risk.
Photographs may be taken at the Clevedon Aquathlon by local press and other participants / supporters.
The event organisers for publicity material such as press releases, TV, media and promotional displays may use these photographs.
I hereby grant Clevedon Aquathlon organisers the absolute right to use images resulting from photography/video at the event. This includes any reproductions or adaptions of the images for all general publicity purposes.
Signature of Participant (all ages) ………………………………………………………………
Date: …………………………………………
Print Name: ………………………………………………………………
British Tri. number if applicable ...............................................................................
Signature of Parent if participant under 18
In addition to the above, I declare that I, or another adult will be present during the event.
Signature of Parent/Guardian ……………………………………………………………...
Date: …………………………………….……
Print Name: …………………………………………………………
Cheques should be made payable to ‘MARLENS’ and sent with the entry form by
NO LATER THAN ONE WEEK BEFORE THE EVENT to:
Jenny Ellis, 5, Tennyson Avenue, Clevedon, North Somerset. BS21 7UQ
Please note – Confirmation of entry will be sent by email or please send a SAE
ORGANISED BY CLEVEDON AMATEUR SWIMMING CLUB, MARLENS & PAC-TRI